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General NPI Number Information
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NPI Number | 1770905655
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Entity Type | Individual
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Provider Name | MR. BOHANAN ANTHONY BENTON
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Gender | Male
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 320 ROBERT S KERR AVE ROOM 505
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City | OKLAHOMA CITY
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State | OK
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Zip | 73102-3457
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Country | US
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Telephone | 405-713-1600
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Fax | 405-235-1567
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Provider Business Mailing Address
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Address Line | 320 ROBERT S KERR AVE ROOM 505
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City | OKLAHOMA CITY
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State | OK
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Zip | 73102-3457
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Country | US
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Telephone | 405-713-1600
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Fax | 405-235-1567
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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