Provider Demographics
NPI:1750659223
Name:ROSS, CALLIE (BHRS)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:812 SW 158TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7623
Mailing Address - Country:US
Mailing Address - Phone:405-735-6160
Mailing Address - Fax:405-242-5070
Practice Address - Street 1:2525 NW EXPRESSWAY
Practice Address - Street 2:SUITE 624 A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7227
Practice Address - Country:US
Practice Address - Phone:405-242-5070
Practice Address - Fax:405-242-5071
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst