Provider Demographics
NPI:1669722062
Name:BEVENUE, AUDREY AURORA (RSS)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:AURORA
Last Name:BEVENUE
Suffix:
Gender:F
Credentials:RSS
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:AURORA
Other - Last Name:BEVENUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 S PEORIA
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4429
Mailing Address - Country:US
Mailing Address - Phone:918-587-9471
Mailing Address - Fax:918-560-1399
Practice Address - Street 1:2325 S HARVARD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114
Practice Address - Country:US
Practice Address - Phone:918-712-4301
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst