Provider Demographics
NPI:1467140129
Name:BLANTON, TERRIL L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TERRIL
Middle Name:L
Last Name:BLANTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TERI
Other - Middle Name:LYNN
Other - Last Name:BLANTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3800 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6639
Mailing Address - Country:US
Mailing Address - Phone:405-942-3800
Mailing Address - Fax:
Practice Address - Street 1:3800 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6639
Practice Address - Country:US
Practice Address - Phone:405-942-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical