Individual
SARA LOUCKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8129 E 16TH ST APT 218, TULSA, OK 74112-8214
(918) 607-6117
Mailing address
8129 E 16TH ST APT 218, TULSA, OK 74112-8214
(918) 607-6117
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053317883
SELF
—
Enumeration date
03/28/2017
Last updated
03/28/2017
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