Provider Demographics
NPI:1316374374
Name:SIMPSON, CHADLEY BLAINE (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:CHADLEY
Middle Name:BLAINE
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 RIMRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-2906
Mailing Address - Country:US
Mailing Address - Phone:405-826-2952
Mailing Address - Fax:
Practice Address - Street 1:4220 RIMRIDGE RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025-2906
Practice Address - Country:US
Practice Address - Phone:405-826-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1899101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor