Roosevelt Premier Therapy

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

ROOSEVELT PREMIER THERAPY

Practice address

1120 N Eastern Ave Ste 108
Moore, OK 73160-5856

Phone

(405) 735-7162

NPI assigned

Jul 12, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Selica Granderson

Title

Director

Phone

(601) 331-4463

Specialties & licenses 10

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1356188692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 325",
            "city": "HUTTO",
            "state": "TX",
            "postal_code": "786340325",
            "telephone_number": "601-331-4463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 N EASTERN AVE STE 108",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731605856",
            "telephone_number": "405-735-7162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOSEVELT PREMIER THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-12",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "GRANDERSON",
        "authorized_official_first_name": "SELICA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-331-4463",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "221700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Art Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Recreation Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Music Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Moore, OK
• Providers in Moore, OK by specialty
• Behavior Analyst in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.