| Intentional Lives Therapy | |
|
3700 Derby Run Dr Edmond OK 73034-2625 | |
| (405) 590-7127 | |
| Not Available |
| Full Name | Intentional Lives Therapy |
|---|---|
| Speciality | Behavior Analyst |
| Location | 3700 Derby Run Dr, Edmond, Oklahoma |
| Authorized Official Name and Position | Rene Daman (OWNER) |
| Authorized Official Contact | 4055907127 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Intentional Lives Therapy 3700 Derby Run Dr Edmond OK 73034-2625 Ph: () - | Intentional Lives Therapy 3700 Derby Run Dr Edmond OK 73034-2625 Ph: (405) 590-7127 |
| NPI Number | 1518604966 |
|---|---|
| Provider Enumeration Date | 05/17/2022 |
| Last Update Date | 05/17/2022 |
| Certification Date | 05/02/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518604966 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 2251P0200X | Physical Therapist - Pediatrics | (* (Not Available)) | Secondary |
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