Provider Demographics
NPI:1124223037
Name:BLACKWOOD, JEAN RENEE (MA, LMFT CANDIDATE)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:RENEE
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:MA, LMFT CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4436 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 24TH AVE NW
Practice Address - Street 2:SUITE E
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6310
Practice Address - Country:US
Practice Address - Phone:405-329-2783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist