Individual
RAVEN NICOLE RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
416 W 15TH ST STE 600, EDMOND, OK 73013-3672
(479) 318-2300
Mailing address
2724 NW 111TH ST, OKLAHOMA CITY, OK 73120-6420
(405) 441-8996
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-291859
OK
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
06/14/2023
Last updated
08/21/2023
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