MEDICARE: MRS. LISA ANTON BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-25-79776

General Provider Information

NPI Number	:	1710323654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA ANTON BCBA

Provider Business Mailing Address
First Line	:	10324 N 127TH EAST AVE
Second Line	:
City	:	OWASSO
State	:	OK
Zip	:	74055-5708
Country	:	US
Telephone Number	:	620-408-5929
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 N ASPEN AVE
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-2205
Country	:	US
Telephone Number	:	620-408-5929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2013
Last Update Date	:	03/06/2025

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