Provider Demographics
NPI:1205109113
Name:CIZEK, RICHARD RILEY
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:RILEY
Last Name:CIZEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 RIDGEWAY ST
Mailing Address - Street 2:
Mailing Address - City:GERONIMO
Mailing Address - State:OK
Mailing Address - Zip Code:73543-9793
Mailing Address - Country:US
Mailing Address - Phone:580-574-4789
Mailing Address - Fax:
Practice Address - Street 1:707 RIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:GERONIMO
Practice Address - State:OK
Practice Address - Zip Code:73543-9793
Practice Address - Country:US
Practice Address - Phone:580-574-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst