Provider Demographics
NPI:1427278431
Name:GUNN, MARK (CADC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GUNN
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 W OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-2238
Mailing Address - Country:US
Mailing Address - Phone:405-293-9159
Mailing Address - Fax:
Practice Address - Street 1:1501 NE 11TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-2605
Practice Address - Country:US
Practice Address - Phone:405-230-1129
Practice Address - Fax:405-424-2810
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)