Individual
MR. BLAKE LUNDRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3475 SOUTHRIDGE PL, UNIT 7, TAHLEQUAH, OK 74464-7912
(918) 931-1041
Mailing address
3475 SOUTHRIDGE PLACE, #7, TAHLEQUAH, OK 74464
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/17/2014
Last updated
01/17/2014
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