Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1124645833 |
---|---|
Provider Name | Mrs. Elizabeth Bley |
First Address | El Reno, OK 73036-0515 |
Second Address | Calumet, OK 73014-6850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2020 |
Last Update Date | 23/07/2020 |