Individual
JAKOB TAYLOR RAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4420 N LINCOLN BLVD, OKLAHOMA CITY, OK 73105-5104
(405) 425-0341
Mailing address
1504 ANDOVER CT, THE VILLAGE, OK 73120-1314
(405) 802-4500
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/02/2021
Last updated
06/03/2022
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