Provider Demographics
NPI:1366063935
Name:WATTS, GABRIELLE R
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:R
Last Name:WATTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361151 E 1000 RD
Mailing Address - Street 2:
Mailing Address - City:PADEN
Mailing Address - State:OK
Mailing Address - Zip Code:74860-7182
Mailing Address - Country:US
Mailing Address - Phone:405-567-9929
Mailing Address - Fax:
Practice Address - Street 1:361151 E 1000 RD
Practice Address - Street 2:
Practice Address - City:PADEN
Practice Address - State:OK
Practice Address - Zip Code:74860-7182
Practice Address - Country:US
Practice Address - Phone:405-567-9929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12545106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist