Provider Demographics
NPI:1265867824
Name:MARTIN-BROWN, BLAKELEA D (LCSW)
Entity Type:Individual
Prefix:
First Name:BLAKELEA
Middle Name:D
Last Name:MARTIN-BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-0936
Mailing Address - Country:US
Mailing Address - Phone:918-440-1658
Mailing Address - Fax:
Practice Address - Street 1:2001 S GARNETT RD
Practice Address - Street 2:SUITE G
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-1836
Practice Address - Country:US
Practice Address - Phone:918-440-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000000000Medicaid