=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831810365
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EISEL BEHAVIOR THERAPY AND CONSULTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2022
-----------------------------------------------------
Last Update Date | 09/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 829 NANCY LYNN TER
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-4223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-605-9131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1110 W MAIN ST # 41
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-6923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | HEATHER EISEL
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 405-605-9131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------