Joel Blackburn
Individual provider Active NPI Peer Specialist · Lawton, OK
NPI 1689247371 · NPPES record last updated Jul 20, 2021
Key facts
- NPI
- 1689247371
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Peer Specialist 175T00000X
- Practice address
- 602 SW 38TH St
Lawton, OK 73505-6912 - Phone
- (580) 248-5780
- NPI assigned
- Jul 20, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | Yes |
Addresses
Primary practice location
602 SW 38TH St
Lawton, OK 73505-6912
Mailing address
602 SW 38TH St
Lawton, OK 73505-6912
Phone (580) 248-5780
Other providers in Lawton, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.