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Behavioral Analyst

Prague, Oklahoma

Provider NPI: 1407091754

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 405-567-0054  Fax: --

Business Mailing Address:
600 E. 12TH  ADA, OK 74820 US
Tel: 580-471-8733  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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