Provider Demographics
NPI:1417228776
Name:CRISP, BARBARA BERNICE
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:BERNICE
Last Name:CRISP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:BERNICE
Other - Last Name:LUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16802 E 380 RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-2911
Mailing Address - Country:US
Mailing Address - Phone:918-344-0126
Mailing Address - Fax:
Practice Address - Street 1:16802 E 380 RD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-2911
Practice Address - Country:US
Practice Address - Phone:918-344-0126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst