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Individual

JAIME A PINE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MED BCBA LBA-OK

Contact information

Practice address
1960 HARPER ST, CHOCTAW, OK 73020-8095
(405) 281-1040
(405) 585-2983
Mailing address
3903 N HARRISON ST, SHAWNEE, OK 74804-1426
(405) 585-2971
(405) 585-2983

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-34407
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200856230A
OK
Enumeration date
11/02/2018
Last updated
11/07/2023
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