Healthcare Provider Details

I. General information

NPI: 1821917493
Provider Name (Legal Business Name): EMMA MA'RYA NYCHOLE SEGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 NW 36TH ST STE 200
OKLAHOMA CITY OK
73112-2916
US

IV. Provider business mailing address

3838 NW 36TH ST STE 200
OKLAHOMA CITY OK
73112-2916
US

V. Phone/Fax

Practice location:
  • Phone: 405-702-9032
  • Fax:
Mailing address:
  • Phone: 405-702-9032
  • 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: