Provider Demographics
NPI:1063734309
Name:WARMACK, GARY HOOPER
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:HOOPER
Last Name:WARMACK
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:HOOPER
Other - Last Name:WARMACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:5201 N VERNON RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73121-5044
Mailing Address - Country:US
Mailing Address - Phone:405-427-0515
Mailing Address - Fax:
Practice Address - Street 1:5201 N VERNON RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73121-5044
Practice Address - Country:US
Practice Address - Phone:405-427-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional