Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013236280 |
---|---|
Provider Name | Ms. Darice Shelton |
First Address | Oklahoma City, OK 73111-6871 |
Second Address | Oklahoma City, OK 73111-6871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2010 |
Last Update Date | 26/05/2010 |