Provider Demographics
NPI:1639426844
Name:OSSENKOP, TERESA (BHRS)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:OSSENKOP
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 SW 111TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-2505
Mailing Address - Country:US
Mailing Address - Phone:405-378-7572
Mailing Address - Fax:
Practice Address - Street 1:2525 NW EXPRESSWAY
Practice Address - Street 2:SUITE 624 A
Practice Address - City:OKLAHOMA
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-242-5070
Practice Address - Fax:405-242-5071
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst