Healthcare Provider Details

I. General information

NPI: 1881333151
Provider Name (Legal Business Name): LOGAN BRANUM BCABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 WASHINGTON DR
NORMAN OK
73069-1028
US

IV. Provider business mailing address

2801 WASHINGTON DR
NORMAN OK
73069-1028
US

V. Phone/Fax

Practice location:
  • Phone: 405-561-5512
  • Fax:
Mailing address:
  • Phone: 505-561-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: