Provider Demographics
NPI:1841386679
Name:JONES, GARY LEE (PHD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6846 S CANTON AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3434
Mailing Address - Country:US
Mailing Address - Phone:539-867-2820
Mailing Address - Fax:877-811-5836
Practice Address - Street 1:6846 S CANTON AVE STE 140
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3434
Practice Address - Country:US
Practice Address - Phone:539-867-2820
Practice Address - Fax:877-811-5836
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100838650AMedicaid
OK100838650AMedicaid