Healthcare Provider Details

I. General information

NPI: 1851211296
Provider Name (Legal Business Name): CECILIA M LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 W ALBUQUERQUE ST
BROKEN ARROW OK
74011-6005
US

IV. Provider business mailing address

1008 W ALBUQUERQUE ST
BROKEN ARROW OK
74011-6005
US

V. Phone/Fax

Practice location:
  • Phone: 539-260-5211
  • Fax:
Mailing address:
  • Phone: 539-260-5211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number00058317
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: