Provider Demographics
NPI:1811239478
Name:STREETMAN, CARRIE (BHRS)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:STREETMAN
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 1:251 E RICHMOND TER
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4938
Mailing Address - Country:US
Mailing Address - Phone:405-205-8814
Mailing Address - Fax:
Practice Address - Street 1:251 E RICHMOND TER
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4938
Practice Address - Country:US
Practice Address - Phone:405-205-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst