Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1023342052 |
---|---|
Provider Name | Miss Nielah Blaylock |
First Address | Oklahoma City, OK 73103-1810 |
Second Address | Oklahoma City, OK 73103-1810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2009 |
Last Update Date | 20/11/2014 |