Provider Demographics
NPI:1255004610
Name:PRIEST, KOURTNEY A
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:A
Last Name:PRIEST
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 1:2600 VAN BUREN ST STE 2634
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-5610
Mailing Address - Country:US
Mailing Address - Phone:405-360-2133
Mailing Address - Fax:
Practice Address - Street 1:124 S BROADWAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5825
Practice Address - Country:US
Practice Address - Phone:405-360-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst