Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-20-41379 | OK |
NPI | 1003167503 |
---|---|
Provider Name | Lindsey Brockie |
First Address | Oklahoma City, OK 73134 |
Second Address | Edmond, OK 73012-9007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2012 |
Last Update Date | 18/08/2021 |