Provider Demographics
NPI:1700515103
Name:RAMBO, GRACIE ARLENE I
Entity type:Individual
Prefix:
First Name:GRACIE
Middle Name:ARLENE
Last Name:RAMBO
Suffix:I
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 1:4200 PERIMETER CTR DR STE 102
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2310
Mailing Address - Country:US
Mailing Address - Phone:405-795-7526
Mailing Address - Fax:
Practice Address - Street 1:4200 PERIMETER CTR DR STE 102
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2310
Practice Address - Country:US
Practice Address - Phone:405-795-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKJCG789171M00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator