Provider Demographics
NPI:1083994602
Name:BLANKENSHIP, STEPHEN W (BHRS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 MARY NIBLACK RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-9495
Mailing Address - Country:US
Mailing Address - Phone:580-221-8740
Mailing Address - Fax:
Practice Address - Street 1:32 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-7013
Practice Address - Country:US
Practice Address - Phone:580-226-5209
Practice Address - Fax:580-226-5219
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049040Medicaid