Provider Demographics
NPI:1265753313
Name:KUTAIT-FAULKNER, NAJLA LOUISE (MED, LBP, BCBA)
Entity type:Individual
Prefix:MRS
First Name:NAJLA
Middle Name:LOUISE
Last Name:KUTAIT-FAULKNER
Suffix:
Gender:F
Credentials:MED, LBP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8612 S LOUISVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2657
Mailing Address - Country:US
Mailing Address - Phone:918-810-3944
Mailing Address - Fax:918-499-1909
Practice Address - Street 1:8612 S LOUISVILLE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2657
Practice Address - Country:US
Practice Address - Phone:918-810-3944
Practice Address - Fax:918-499-1909
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0062101YM0800X
OK1000143103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0062OtherLICENSED BEHAVIORAL PRACTITIONER