Provider Demographics
NPI:1225644040
Name:LAWRENCE, MACKENNA (RBT, COTA/L)
Entity Type:Individual
Prefix:
First Name:MACKENNA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:RBT, COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 24TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6392
Mailing Address - Country:US
Mailing Address - Phone:405-857-8280
Mailing Address - Fax:405-857-8489
Practice Address - Street 1:1806 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6392
Practice Address - Country:US
Practice Address - Phone:405-857-8280
Practice Address - Fax:405-857-8489
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT20135901106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician