Healthcare Provider Details

I. General information

NPI: 1083391254
Provider Name (Legal Business Name): NATHAN DANIEL UNRUH BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15809 NE 23RD ST
CHOCTAW OK
73020-8428
US

IV. Provider business mailing address

3903 N HARRISON ST
SHAWNEE OK
74804-1426
US

V. Phone/Fax

Practice location:
  • Phone: 405-281-1040
  • Fax:
Mailing address:
  • Phone: 405-628-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88155
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: