Provider Demographics
NPI:1871834622
Name:WILLIS CHILDS, TUNICIA L (BS)
Entity Type:Individual
Prefix:
First Name:TUNICIA
Middle Name:L
Last Name:WILLIS CHILDS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SE 89TH ST
Mailing Address - Street 2:201
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73149-1914
Mailing Address - Country:US
Mailing Address - Phone:405-201-3199
Mailing Address - Fax:
Practice Address - Street 1:201 SE 89TH ST
Practice Address - Street 2:201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73149-1914
Practice Address - Country:US
Practice Address - Phone:405-201-3199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst