Provider Demographics
NPI:1184156549
Name:REDDING, EMILY DANIELLE (BCBA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:DANIELLE
Last Name:REDDING
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 NW GOODYEAR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9716
Mailing Address - Country:US
Mailing Address - Phone:940-473-9272
Mailing Address - Fax:
Practice Address - Street 1:3005 SW PARK AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-7902
Practice Address - Country:US
Practice Address - Phone:580-699-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-17-25705103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst