Healthcare Provider Details

I. General information

NPI: 1417630724
Provider Name (Legal Business Name): BCB WEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 NW 164TH TER
EDMOND OK
73013-9471
US

IV. Provider business mailing address

3517 NW 164TH TER
EDMOND OK
73013-9471
US

V. Phone/Fax

Practice location:
  • Phone: 405-562-3776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDSAY STUART
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 405-562-3776