Ethan Everett Blasdel, MS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

421 E Thomas Ave
Stillwater, OK 74075-2600

Phone

(405) 372-2202

Fax

(405) 445-3780

NPI assigned

Mar 19, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grand Lake Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Miami, OK
  • NPI 1497762520
  Medicare reassignment
• Grand Lake Mental Health Center, Inc.

  • Community/Behavioral Health Agency
  • Tulsa, OK
  • NPI 1356048656
  NPD
• Grand Lake Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Blackwell, OK
  • NPI 1457922528
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521417600000",
    "number": "1821592544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 E THOMAS AVE",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740752600",
            "telephone_number": "405-372-2202",
            "fax_number": "405-445-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 E THOMAS AVE",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740752600",
            "telephone_number": "405-372-2202",
            "fax_number": "405-445-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLASDEL",
        "first_name": "ETHAN",
        "middle_name": "EVERETT",
        "credential": "MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-19",
        "last_updated": "2018-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Amariah Blair
• Scott William Blair
• Amanda Lynne Blalock, BA
• Debbie Deneice Blan, RN
• Kristen Ann Blankenship, RN
• Carmen Elyse Blatnick, DPT
• Jimmie Sue Blose, LPC
• Allyson Raquel Blosser
• Sean Matthew Boehm
• Savanna Ann Bojorquez

• Mental Health Counselor in Stillwater, OK
• Providers in Stillwater, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.