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General NPI Number Information
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NPI Number | 1649085911
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Entity Type | Organization
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Legal Business Name | MASTER IT BEHAVIOR THERAPY OF OKLAHOMA
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 629 W MAIN ST STE 1056
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City | OKLAHOMA CITY
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State | OK
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Zip | 73102-2221
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Country | US
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Telephone | 833-653-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 629 W MAIN ST STE 1056
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City | OKLAHOMA CITY
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State | OK
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Zip | 73102-2221
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | CHANA KOLKO
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Credential |
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Telephone | 833-653-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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