Individual
MRS. REBECCA S BLAKE I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
408 S 17TH ST, CLINTON, OK 73601-4236
(580) 323-0312
Mailing address
408 N MO ST, THOMAS, OK 73369
(580) 661-2904
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
37V350170804
OK
172V00000X
Community Health Worker
Primary
37V350170804
OK
Other
Enumeration date
07/01/2008
Last updated
07/22/2008
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