Provider Demographics
NPI:1013208214
Name:BLANCHARD, MARK ALAN (BS, BHRS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:BS, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 S OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-7420
Mailing Address - Country:US
Mailing Address - Phone:580-237-1494
Mailing Address - Fax:
Practice Address - Street 1:1625 W OWEN K GARRIOTT RD
Practice Address - Street 2:STE F
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5653
Practice Address - Country:US
Practice Address - Phone:580-242-4673
Practice Address - Fax:580-242-4679
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health