Provider Demographics
NPI:1821370925
Name:CHOICE, MARIO BOBBIE (ED)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:BOBBIE
Last Name:CHOICE
Suffix:
Gender:M
Credentials:ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 S 124TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3220
Mailing Address - Country:US
Mailing Address - Phone:918-951-5189
Mailing Address - Fax:
Practice Address - Street 1:3607 S 124TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3220
Practice Address - Country:US
Practice Address - Phone:918-951-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst