Provider Demographics
NPI:1336232206
Name:BLACK, SYDNEY D (MS LPC LBP)
Entity Type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:D
Last Name:BLACK
Suffix:
Gender:F
Credentials:MS LPC LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 S BRADEN AVE
Mailing Address - Street 2:DR STUART HOLDERNESS & ASSOCIATES
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136
Mailing Address - Country:US
Mailing Address - Phone:918-499-0300
Mailing Address - Fax:918-499-0357
Practice Address - Street 1:7151 S BRADEN AVE
Practice Address - Street 2:DR STUART HOLDERNESS & ASSOCIATES
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-499-0300
Practice Address - Fax:918-499-0357
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1996101YP2500X
OK0038106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist