Provider Demographics
NPI:1902132228
Name:ALLISON, BENJAMIN REX
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:REX
Last Name:ALLISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-7762
Mailing Address - Country:US
Mailing Address - Phone:405-820-4965
Mailing Address - Fax:
Practice Address - Street 1:7804 NW 89TH ST STE 1
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-3213
Practice Address - Country:US
Practice Address - Phone:405-820-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5814101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health