Provider Demographics
NPI:1659813970
Name:BAILEY, RICHARD BERNARD (INTERN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BERNARD
Last Name:BAILEY
Suffix:
Gender:M
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-2617
Mailing Address - Country:US
Mailing Address - Phone:405-606-2528
Mailing Address - Fax:405-606-2531
Practice Address - Street 1:1900 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-2617
Practice Address - Country:US
Practice Address - Phone:405-606-2528
Practice Address - Fax:405-606-2531
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician