Healthcare Provider Details

I. General information

NPI: 1417218728
Provider Name (Legal Business Name): LISA HARBISON BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 E US HIGHWAY 66
EL RENO OK
73036-9225
US

IV. Provider business mailing address

4400 BUCKHORN LN
EL RENO OK
73036-7706
US

V. Phone/Fax

Practice location:
  • Phone: 405-262-0202
  • Fax:
Mailing address:
  • Phone: 405-641-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: