MEDICARE: ELISE D HENSON RBT

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	106S00000X	Behavior Technician	RBT-23-302420	OK

General Provider Information

NPI Number	:	1972384667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE D HENSON RBT

Provider Business Mailing Address
First Line	:	1900 E 15TH ST STE 800B
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-6682
Country	:	US
Telephone Number	:	405-455-6868
Fax Number	:	405-562-3444

Provider Business Practice Location Address
First Line	:	1900 E 15TH ST BLDG 900
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-6610
Country	:	US
Telephone Number	:	405-455-6868
Fax Number	:	405-562-3444

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

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	12/11/2025

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Directions to “ ELISE D HENSON RBT” Practice Location

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