Provider Demographics
NPI:1790574069
Name:AL-KHATEIB, PARIS ROWYN
Entity type:Individual
Prefix:
First Name:PARIS
Middle Name:ROWYN
Last Name:AL-KHATEIB
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3453
Mailing Address - Country:US
Mailing Address - Phone:580-380-8081
Mailing Address - Fax:
Practice Address - Street 1:107 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-4700
Practice Address - Country:US
Practice Address - Phone:580-706-6936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician