Individual
MS. GRACE BLANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
704 W CARSON DR, MUSTANG, OK 73064-3578
(405) 431-8018
Mailing address
704 W CARSON DR, MUSTANG, OK 73064-3578
(405) 431-8018
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/25/2013
Last updated
07/25/2013
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