Basic Information
| Provider Information | |||||||||
| NPI: | 1134696610 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | BACB | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 E 15TH ST STE 800B | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730136682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054556868 | ||||||||
| FaxNumber: | 4055623444 | ||||||||
| Practice Location | |||||||||
| Address1: | 1212 S AIR DEPOT BLVD STE 9 | ||||||||
| Address2: | |||||||||
| City: | MIDWEST CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731104860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054556868 | ||||||||
| FaxNumber: | 8008560132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2018 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | RBT-17-4070 | OK | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | 1-22-60065 | OK | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.