Individual
ADELINE YOUNGBLOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.B.S., L.P.C.C
Contact information
Practice address
612 E JACKSON, HUGO, OK 74743
(580) 326-2200
(580) 326-2201
Mailing address
612 E JACKSON, HUGO, OK 74743
(580) 326-2200
(580) 326-2201
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
731526909
—
OK
Enumeration date
01/30/2009
Last updated
05/25/2012
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