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General NPI Number Information
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NPI Number | 1073248522
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Entity Type | Individual
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Provider Name | JULIE BLACK
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Gender | Female
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 2121 E MAIN ST STE 1
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City | WEATHERFORD
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State | OK
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Zip | 73096-6030
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Country | US
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Telephone | 405-857-8280
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Fax |
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Provider Business Mailing Address
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Address Line | 3635 NW 39TH EXPRESSWAY
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-6309
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Country | US
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Telephone | 405-857-8280
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-227005
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License Number State | OK
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