Provider Demographics
NPI:1235414160
Name:PRATT, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73122-6110
Mailing Address - Country:US
Mailing Address - Phone:405-305-1105
Mailing Address - Fax:405-608-4503
Practice Address - Street 1:5309 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73122-6110
Practice Address - Country:US
Practice Address - Phone:405-305-1105
Practice Address - Fax:405-608-4503
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK01Medicaid