Individual
JACE CARLTON CHRISTOPHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 SMOKING TREE ST, MOORE, OK 73160-5718
(304) 991-2344
Mailing address
1500 SMOKING TREE ST, MOORE, OK 73160-5718
(304) 991-2344
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-346248
OK
Other
Enumeration date
05/13/2024
Last updated
05/13/2024
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