Healthcare Provider Details

I. General information

NPI: 1780592154
Provider Name (Legal Business Name): LENNY DAVIDSON RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3954 KICKAPOO ST SUITE 1
SHAWNEE OK
74804-1698
US

IV. Provider business mailing address

338032 E HIGHWAY 62
MEEKER OK
74855-3211
US

V. Phone/Fax

Practice location:
  • Phone: 405-857-8280
  • Fax: 405-857-8489
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-2843871
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: