Provider Demographics
NPI:1881904761
Name:BLAKEMORE, KRISTI KATHRYN (M ED, BHRS)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:KATHRYN
Last Name:BLAKEMORE
Suffix:
Gender:F
Credentials:M ED, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-1828
Mailing Address - Country:US
Mailing Address - Phone:405-831-9844
Mailing Address - Fax:
Practice Address - Street 1:5116 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2077
Practice Address - Country:US
Practice Address - Phone:405-943-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK303586101YS0200X
103K00000X
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst