Individual
CHRISTIAN DENELL RILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
711 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-4717
(918) 207-0078
Mailing address
411 E WARD ST, TAHLEQUAH, OK 74464-2948
(205) 276-1355
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92293023801
—
AL
Enumeration date
09/08/2019
Last updated
09/08/2019
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