Healthcare Provider Details

I. General information

NPI: 1740104611
Provider Name (Legal Business Name): DIAMOND WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 S DENVER AVE
TULSA OK
74119-1039
US

IV. Provider business mailing address

504 S MERIDIAN AVE
OKLAHOMA CITY OK
73108-1016
US

V. Phone/Fax

Practice location:
  • Phone: 571-666-6704
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-532025
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: