Basic Information
| Provider Information | |||||||||
| NPI: | 1952648024 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIBLE | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | BHRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1069 E 144TH PL | ||||||||
| Address2: | |||||||||
| City: | GLENPOOL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740333756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188098049 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6216 S LEWIS AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741361044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9189607852 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2013 | ||||||||
| LastUpdateDate: | 01/09/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | OK | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.