Basic Information
| Provider Information | |||||||||
| NPI: | 1891087847 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLOUNT | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | BHRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 721562 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730708202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058160537 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4436 NW 50TH ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731122212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058582716 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2011 | ||||||||
| LastUpdateDate: | 07/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | OK | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.