Individual
COREY IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 NW 10TH ST, OKLAHOMA CITY, OK 73106-7220
(405) 528-4673
(405) 528-4674
Mailing address
900 NW 10TH ST, OKLAHOMA CITY, OK 73106-7220
(405) 528-4673
(405) 528-4674
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
10/15/2010
Last updated
10/15/2010
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