Provider Demographics
NPI:1528455540
Name:BRANUM, ALICIA RENEE (M ED BCBA)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:RENEE
Last Name:BRANUM
Suffix:
Gender:F
Credentials:M ED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W CHEYENNE ST
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-3067
Mailing Address - Country:US
Mailing Address - Phone:580-641-2527
Mailing Address - Fax:
Practice Address - Street 1:810 W CHEYENNE ST
Practice Address - Street 2:
Practice Address - City:MARLOW
Practice Address - State:OK
Practice Address - Zip Code:73055-3067
Practice Address - Country:US
Practice Address - Phone:580-641-2527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11416511103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst