Individual
BLONG LOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
6400 S LEWIS AVE STE 100, TULSA, OK 74136-1019
(405) 378-2727
Mailing address
6400 S LEWIS AVE STE 100, TULSA, OK 74136-1019
(405) 378-2727
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC07377
OK
101YP2500X
Professional Counselor
LPC07377
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200323940
—
OK
Enumeration date
03/07/2018
Last updated
02/26/2025
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