Provider Demographics
NPI:1093409575
Name:CIFUENTES, JESSICA EMILY (RBT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:EMILY
Last Name:CIFUENTES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 NW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-4418
Mailing Address - Country:US
Mailing Address - Phone:405-404-6227
Mailing Address - Fax:
Practice Address - Street 1:14828 SERENITA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-2028
Practice Address - Country:US
Practice Address - Phone:405-839-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-23-277607106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician