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Behavioral Analyst

Tishomingo, Oklahoma

Provider NPI: 1558506972

Provider Information:
Gender: F
Sole Proprietor

Practice Location:
Tel: 580-371-3799  Fax: --

Business Mailing Address:
4607 N.B.U.  PRAGUE, OK 74864 US
Tel: 405-567-9219  Fax: --

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number


Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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