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General NPI Number Information
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NPI Number | 1861936767
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Entity Type | Organization
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Legal Business Name | MOMENTUM BEHAVIORAL SOLUTIONS
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 2449 NW 198TH ST
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City | EDMOND
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State | OK
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Zip | 73012-5236
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Country | US
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Telephone | 405-693-5675
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Fax |
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Provider Business Mailing Address
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Address Line | 2449 NW 198TH ST
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City | EDMOND
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State | OK
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Zip | 73012-5236
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Country | US
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Telephone | 405-693-5675
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR ANALYST/CO-OWNER
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Name | TIFFANIE MOORE
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Credential | BCBA, NCSP
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Telephone | 405-693-5675
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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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