Provider Demographics
NPI:1194000133
Name:SAMPLES, KORI CHALYN (BA)
Entity Type:Individual
Prefix:MISS
First Name:KORI
Middle Name:CHALYN
Last Name:SAMPLES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 NW 122ND ST.
Mailing Address - Street 2:#2414
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120
Mailing Address - Country:US
Mailing Address - Phone:918-521-2233
Mailing Address - Fax:
Practice Address - Street 1:2301 NW 122ND ST
Practice Address - Street 2:#2414
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8447
Practice Address - Country:US
Practice Address - Phone:918-521-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst