Provider Demographics
NPI:1689262339
Name:WELLS, KARSTEN CONNER (RBT)
Entity Type:Individual
Prefix:
First Name:KARSTEN
Middle Name:CONNER
Last Name:WELLS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8512 NW 114TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2237
Mailing Address - Country:US
Mailing Address - Phone:405-625-7860
Mailing Address - Fax:
Practice Address - Street 1:8512 NW 114TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-2237
Practice Address - Country:US
Practice Address - Phone:405-625-7860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKH083926704106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician