Provider Demographics
NPI:1376959965
Name:MARTIN, JULIA (BCBA, LBA-OK)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BCBA, LBA-OK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 S COOK AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-5220
Mailing Address - Country:US
Mailing Address - Phone:580-721-0318
Mailing Address - Fax:408-217-4813
Practice Address - Street 1:1503 ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-3012
Practice Address - Country:US
Practice Address - Phone:580-721-0318
Practice Address - Fax:408-217-4813
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-13-14549103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1-13-14549OtherLBA
OK200849880AMedicaid