Provider Demographics
NPI:1184317497
Name:BLAIN, SYMONE (RBT)
Entity type:Individual
Prefix:
First Name:SYMONE
Middle Name:
Last Name:BLAIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 S POST RD STE B
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-6614
Mailing Address - Country:US
Mailing Address - Phone:405-394-4831
Mailing Address - Fax:
Practice Address - Street 1:1712 S POST RD STE B
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6614
Practice Address - Country:US
Practice Address - Phone:405-394-4831
Practice Address - Fax:405-610-5259
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-23-276658106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician