Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003155169 |
---|---|
Provider Name | Gregory Tywon Richmond |
First Address | Oklahoma City, OK 73103-1515 |
Second Address | Oklahoma City, OK 73103-1515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2013 |
Last Update Date | 10/02/2013 |