Provider Demographics
NPI:1831853613
Name:KULESSA, ANDREA MARIE (RBT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:KULESSA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 N BROOKLINE AVE STE 525
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3627
Mailing Address - Country:US
Mailing Address - Phone:405-503-0863
Mailing Address - Fax:
Practice Address - Street 1:5100 N BROOKLINE AVE STE 525
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-503-0863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1295126936OtherPRIVATE INSURANCE