Individual
STACEY R BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
7127 S OLYMPIA AVE, TULSA, OK 74132-1856
(918) 665-9500
Mailing address
7127 S OLYMPIA AVE, TULSA, OK 74132-1856
(918) 665-9500
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5795
OK
Other
Enumeration date
04/13/2023
Last updated
04/13/2023
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