Provider Demographics
NPI:1538781406
Name:WORSHAM, JESSICA (RBT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WORSHAM
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 S. SANTE FE AVE.
Mailing Address - Street 2:APT 102
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160
Mailing Address - Country:US
Mailing Address - Phone:209-480-0091
Mailing Address - Fax:
Practice Address - Street 1:1806 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6392
Practice Address - Country:US
Practice Address - Phone:405-482-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106E00000X
OKRBT20117297106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst