Provider Demographics
NPI:1366059909
Name:WILLIAMS, RICHARD (RBT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 S. DOUGLAS BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130
Mailing Address - Country:US
Mailing Address - Phone:405-582-3990
Mailing Address - Fax:405-458-8019
Practice Address - Street 1:1121 S. DOUGLAS BOULEVARD
Practice Address - Street 2:SUITE A
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130
Practice Address - Country:US
Practice Address - Phone:405-582-3990
Practice Address - Fax:405-458-8019
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-20-136547106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKA083634017OtherDRIVERS LICENSE