MEDICARE: DR. BLAKE T HILTON PSYD

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	103TC0700X	Clinical Psychologist	10917	MA

General Provider Information

NPI Number	:	1295253144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAKE T HILTON PSYD

Provider Business Mailing Address
First Line	:	920 STANTON L YOUNG BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5036
Country	:	US
Telephone Number	:	405-271-5251
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 NW 39TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7123
Country	:	US
Telephone Number	:	405-443-8788
Fax Number	:

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

Provider Enumeration Date	:	08/30/2017
Last Update Date	:	09/22/2023

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