Provider Demographics
NPI:1548595366
Name:BLANKENSHIP, SHARIE (LPC)
Entity Type:Individual
Prefix:
First Name:SHARIE
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 MARY NIBLACK RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-9495
Mailing Address - Country:US
Mailing Address - Phone:580-226-5209
Mailing Address - Fax:
Practice Address - Street 1:1495 MARY NIBLACK RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-9495
Practice Address - Country:US
Practice Address - Phone:580-226-5209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional