Provider Demographics
NPI:1609054576
Name:GARY L JONES PHD PLLC
Entity type:Organization
Organization Name:GARY L JONES PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:539-867-2820
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-03
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100838650AMedicaid
OK400522412Medicare PIN