Provider Demographics
NPI:1225925381
Name:BLACK, TAYAH MARIE (RBT)
Entity type:Individual
Prefix:
First Name:TAYAH
Middle Name:MARIE
Last Name:BLACK
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 1:406 E HALL OF FAME AVE STE 50
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-5428
Mailing Address - Country:US
Mailing Address - Phone:918-216-0242
Mailing Address - Fax:405-757-0727
Practice Address - Street 1:406 E HALL OF FAME AVE STE 50
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-5428
Practice Address - Country:US
Practice Address - Phone:918-216-0242
Practice Address - Fax:405-757-0727
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-21
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-25-446476106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician