Provider Demographics
NPI:1730438342
Name:HARLIN, GORDON KEITH
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:KEITH
Last Name:HARLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 N MAIN
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401
Mailing Address - Country:US
Mailing Address - Phone:918-682-8407
Mailing Address - Fax:918-687-0976
Practice Address - Street 1:619 N MAIN
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401
Practice Address - Country:US
Practice Address - Phone:918-682-8407
Practice Address - Fax:918-687-0976
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker