Provider Demographics
NPI:1205075686
Name:A BLESSED CHILD, LLC
Entity type:Organization
Organization Name:A BLESSED CHILD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:D
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-816-3078
Mailing Address - Street 1:5909 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5161
Mailing Address - Country:US
Mailing Address - Phone:405-816-3078
Mailing Address - Fax:
Practice Address - Street 1:5909 NW EXPRESSWAY
Practice Address - Street 2:SUITE 207
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-5161
Practice Address - Country:US
Practice Address - Phone:405-816-3078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health