Provider Demographics
NPI:1083058895
Name:INFANT PARENT INTERVENTION CENTER
Entity Type:Organization
Organization Name:INFANT PARENT INTERVENTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-602-3171
Mailing Address - Street 1:2242 NW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8884
Mailing Address - Country:US
Mailing Address - Phone:405-602-3171
Mailing Address - Fax:405-602-3226
Practice Address - Street 1:2242 NW 39TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8884
Practice Address - Country:US
Practice Address - Phone:405-602-3171
Practice Address - Fax:405-602-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health