Provider Demographics
NPI:1679042063
Name:POE, VERNA GALE (BCBA)
Entity Type:Individual
Prefix:
First Name:VERNA
Middle Name:GALE
Last Name:POE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 ROCKY MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4640
Mailing Address - Country:US
Mailing Address - Phone:405-361-8837
Mailing Address - Fax:
Practice Address - Street 1:409 S FRETZ AVE STE D
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5570
Practice Address - Country:US
Practice Address - Phone:405-216-3391
Practice Address - Fax:405-216-3391
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-20-45911103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst