Individual
EBONY SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4515 E 91ST ST, TULSA, OK 74137-2861
(855) 782-7822
Mailing address
2405 PALMER CIR STE 100, NORMAN, OK 73069-6351
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-276971
OK
Other
Enumeration date
06/07/2023
Last updated
06/07/2023
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