Healthcare Provider Details

I. General information

NPI: 1083343131
Provider Name (Legal Business Name): CHENOA BURLESON BHCM II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E MAIN ST
NORMAN OK
73071-5300
US

IV. Provider business mailing address

4601 HERITAGE PLACE DR APT 806
NORMAN OK
73072-4332
US

V. Phone/Fax

Practice location:
  • Phone: 405-573-3812
  • Fax:
Mailing address:
  • Phone: 806-440-2854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: