Provider Demographics
NPI:1851950851
Name:BLANKENSHIP, OKSANA
Entity Type:Individual
Prefix:
First Name:OKSANA
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OKSANA
Other - Middle Name:
Other - Last Name:SKLYAROV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:200 W MAGNOLIA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7657
Mailing Address - Country:US
Mailing Address - Phone:817-702-2977
Mailing Address - Fax:817-702-2140
Practice Address - Street 1:601 W TERRELL AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3243
Practice Address - Country:US
Practice Address - Phone:308-632-8547
Practice Address - Fax:308-632-0135
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX39802OtherSTATE LICENSE