Healthcare Provider Details

I. General information

NPI: 1679255079
Provider Name (Legal Business Name): KATHERINE L ANSBOURY RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11412 N 134TH EAST AVE STE C3
OWASSO OK
74055-4969
US

IV. Provider business mailing address

4620 S ASPEN AVE APT 1103
BROKEN ARROW OK
74011-2140
US

V. Phone/Fax

Practice location:
  • Phone: 210-440-1903
  • Fax:
Mailing address:
  • Phone: 210-440-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-85264
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-85264
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: