Provider Demographics
NPI:1740876416
Name:ALCALA, JAZMINE RAEANN (RBT-20-148585)
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:RAEANN
Last Name:ALCALA
Suffix:
Gender:F
Credentials:RBT-20-148585
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14900 N PENNSYLVANIA AVE APT 1934
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-5914
Mailing Address - Country:US
Mailing Address - Phone:623-332-3874
Mailing Address - Fax:
Practice Address - Street 1:13905 TECHNOLOGY DR # A1
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1054
Practice Address - Country:US
Practice Address - Phone:405-389-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst