Healthcare Provider Details

I. General information

NPI: 1174358105
Provider Name (Legal Business Name): EMILY MARTINEZ BLEVINS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY MARTINEZ

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7837 S PARK AVE
BROKEN ARROW OK
74011-6446
US

IV. Provider business mailing address

7837 S PARK AVE
BROKEN ARROW OK
74011-6446
US

V. Phone/Fax

Practice location:
  • Phone: 918-313-5197
  • Fax:
Mailing address:
  • Phone: 918-313-5197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9179
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: