Provider Demographics
NPI:1083682306
Name:BLACKBURN, CLARE ELLEN (LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:CLARE
Middle Name:ELLEN
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 N PORTLAND AVE
Mailing Address - Street 2:STE. 315
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1662
Mailing Address - Country:US
Mailing Address - Phone:405-949-2593
Mailing Address - Fax:405-942-1633
Practice Address - Street 1:5700 N PORTLAND AVE
Practice Address - Street 2:STE. 315
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1662
Practice Address - Country:US
Practice Address - Phone:405-949-2593
Practice Address - Fax:405-942-1633
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3011101YP2500X
OK070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist