Provider Demographics
NPI:1275977209
Name:BLACKWELL, CINDY LOUISE
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:LOUISE
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 NE 33RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73121-6659
Mailing Address - Country:US
Mailing Address - Phone:405-821-7619
Mailing Address - Fax:
Practice Address - Street 1:2520 NW 39TH EXPY # MAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3760
Practice Address - Country:US
Practice Address - Phone:405-408-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst