MEDICARE: MS. CLARE ELLEN BLACKBURN LPC, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3011	OK
2	106H00000X	Marriage & Family Therapist	070	OK

General Provider Information

NPI Number	:	1083682306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CLARE ELLEN BLACKBURN LPC, LMFT

Provider Business Mailing Address
First Line	:	5700 N PORTLAND AVE
Second Line	:	STE. 315
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1662
Country	:	US
Telephone Number	:	405-949-2593
Fax Number	:	405-942-1633

Provider Business Practice Location Address
First Line	:	5700 N PORTLAND AVE
Second Line	:	STE. 315
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1662
Country	:	US
Telephone Number	:	405-949-2593
Fax Number	:	405-942-1633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2006
Last Update Date	:	09/11/2025

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