Provider Demographics
NPI:1972121291
Name:BELLER, ELIZABETH (CERTIFIED SPECIAL ED)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BELLER
Suffix:
Gender:F
Credentials:CERTIFIED SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3963 S HIGHWAY 97 # 203
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-3829
Mailing Address - Country:US
Mailing Address - Phone:512-599-0197
Mailing Address - Fax:
Practice Address - Street 1:129 S 175TH WEST AVE
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-5214
Practice Address - Country:US
Practice Address - Phone:512-599-0197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK443606174H00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator