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General NPI Number Information
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NPI Number | 1982202438
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Entity Type | Individual
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Provider Name | SCOTT ALEXANDER BLACKBURN LMSW-P
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Gender | Male
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 124 E 6TH ST
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City | PAWHUSKA
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State | OK
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Zip | 74056-4204
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Country | US
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Telephone | 918-604-6054
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Fax |
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Provider Business Mailing Address
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Address Line | 325 S ASH ST
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City | NOWATA
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State | OK
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Zip | 74048-4628
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Country | US
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Telephone | 918-273-7344
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Fax | 918-999-0111
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7530-P
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License Number State | OK
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