Individual
MS. LAKISHA S BURROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 PINEHURST DR, OKLAHOMA CITY, OK 73130-3208
(405) 600-5154
Mailing address
401 PINEHURST DR, OKLAHOMA CITY, OK 73130-3208
(405) 600-5154
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
KO81319431
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OC4184
OTHER INS
OK
Enumeration date
10/09/2012
Last updated
10/09/2012
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