Healthcare Provider Details

I. General information

NPI: 1093017436
Provider Name (Legal Business Name): BLAIR NICOLE HARTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 W OXFORD AVE
ENID OK
73701-1208
US

IV. Provider business mailing address

605 W OXFORD AVE
ENID OK
73701-1208
US

V. Phone/Fax

Practice location:
  • Phone: 580-233-7220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2010038925
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5475
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: