Individual
LISA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
900 E MAIN ST, NORMAN, OK 73071-5305
(405) 321-4880
Mailing address
900 E MAIN ST, NORMAN, OK 73071-5305
(405) 321-4880
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/28/2022
Last updated
12/28/2022
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