Provider Demographics
NPI:1639502578
Name:BLAKE, ASHTON D
Entity Type:Individual
Prefix:MISS
First Name:ASHTON
Middle Name:D
Last Name:BLAKE
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 1:207 E PLEASANT HILL DR APT 108
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-3002
Mailing Address - Country:US
Mailing Address - Phone:918-852-5583
Mailing Address - Fax:
Practice Address - Street 1:207 E PLEASANT HILL DR APT 108
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-3002
Practice Address - Country:US
Practice Address - Phone:918-852-5583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor