Individual
CHARLES BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5128 NW 19TH TER, OKLAHOMA CITY, OK 73127-2306
(405) 886-4671
Mailing address
351 N AIR DEPOT BLVD STE M, MIDWEST CITY, OK 73110-1760
(405) 610-3644
(405) 610-3647
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
02/27/2014
Last updated
02/27/2014
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