Individual
BREANAH MASSENGALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
309 SW 59TH ST, OKLAHOMA CITY, OK 73109-8321
(405) 999-0569
Mailing address
608 W KIOWA ST, LINDSAY, OK 73052-6034
(405) 999-0569
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
OK
Other
Enumeration date
05/08/2023
Last updated
05/08/2023
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