MEDICARE: BENNY NAIFEH

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

General Provider Information

NPI Number	:	1790465169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENNY NAIFEH

Provider Business Mailing Address
First Line	:	2126 E OKLAHOMA ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74110-4623
Country	:	US
Telephone Number	:	918-852-2196
Fax Number	:

Provider Business Practice Location Address
First Line	:	2126 E OKLAHOMA ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74110-4623
Country	:	US
Telephone Number	:	918-852-2196
Fax Number	:

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

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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Directions to “ BENNY NAIFEH ” Practice Location

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