Provider Demographics
NPI:1588919013
Name:GRUENWALD, CALLIE ANNE (MS, LPC CANDIDATE)
Entity type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:ANNE
Last Name:GRUENWALD
Suffix:
Gender:F
Credentials:MS, LPC CANDIDATE
Other - Prefix:MS
Other - First Name:CALLIE
Other - Middle Name:ANN
Other - Last Name:ULM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC CANDIDATE
Mailing Address - Street 1:2800 SW 109TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-2462
Mailing Address - Country:US
Mailing Address - Phone:405-606-1723
Mailing Address - Fax:
Practice Address - Street 1:2800 SW 109TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-2462
Practice Address - Country:US
Practice Address - Phone:405-606-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional