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General NPI Number Information
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NPI Number | 1417874421
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Entity Type | Organization
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Legal Business Name | KORTNEY RIST-GILL PHD BCBA, LLC
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Dates
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Enumeration Date | 07/01/2026
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Last Update Date | 07/01/2026
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Provider Practice Location Address
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Address Line | 517 LIBERTY LN STE 100
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City | EDMOND
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State | OK
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Zip | 73034-9046
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Country | US
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Telephone | 405-285-2110
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Fax | 405-216-3362
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Provider Business Mailing Address
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Address Line | 517 LIBERTY LN STE 100
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City | EDMOND
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State | OK
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Zip | 73034-9046
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Country | US
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Telephone | 405-285-2110
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Fax | 405-216-3362
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | KORTNEY RIST
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Credential | PHD, BCBA
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Telephone | 913-634-4224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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