Individual
KRISTEN NICOLE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2325 S HARVARD AVE, TULSA, OK 74114-3300
(918) 712-4301
Mailing address
1008 W INGLEWOOD ST, BROKEN ARROW, OK 74011-4432
(918) 637-0203
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
OK
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
730580270
GROUP FEIN
OK
Enumeration date
05/20/2021
Last updated
10/10/2022
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