Provider Demographics
NPI:1922381284
Name:BLUT JER-DON, DAFNA (MED, LPC)
Entity Type:Individual
Prefix:
First Name:DAFNA
Middle Name:
Last Name:BLUT JER-DON
Suffix:
Gender:F
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:PO BOX 12426
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-2426
Mailing Address - Country:US
Mailing Address - Phone:405-412-8198
Mailing Address - Fax:405-810-8977
Practice Address - Street 1:3201 N MUSTANG RD
Practice Address - Street 2:STE A & B
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-3399
Practice Address - Country:US
Practice Address - Phone:405-810-0054
Practice Address - Fax:405-810-8977
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1317101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health