Individual
GARY FRED BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
323 W 6TH ST, OKMULGEE, OK 74447-5019
(918) 756-9250
(918) 756-9187
Mailing address
323 W 6TH ST, OKMULGEE, OK 74447-5019
(918) 756-9250
(918) 756-9187
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2249
OK
Other
Enumeration date
03/19/2008
Last updated
03/19/2008
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