Provider Demographics
NPI:1871182915
Name:REIBERT, BONNY (RBT)
Entity Type:Individual
Prefix:
First Name:BONNY
Middle Name:
Last Name:REIBERT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-9432
Mailing Address - Country:US
Mailing Address - Phone:918-410-9668
Mailing Address - Fax:
Practice Address - Street 1:600 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-9432
Practice Address - Country:US
Practice Address - Phone:918-410-9668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT20145875106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200868060AMedicaid
OK822465485Medicaid