Healthcare Provider Details

I. General information

NPI: 1952648024
Provider Name (Legal Business Name): JAY MICHAEL BIBLE BHRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6216 S LEWIS AVE
TULSA OK
74136-1044
US

IV. Provider business mailing address

1069 E 144TH PL
GLENPOOL OK
74033-3756
US

V. Phone/Fax

Practice location:
  • Phone: 918-960-7852
  • Fax:
Mailing address:
  • Phone: 918-809-8049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: