| Doctor Name: | ANDREA MICHELLE BLANK |
| NPI Number: | 1114924628 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 2265 |
| Business Practice Address: | 900 E Airport Rd Box 1118 Okmulgee, OK - 744479082 |
| Business Phone Number: | 9187569211 |
| Business Fax Number: | 9187569452 |
| Mailing Address: | 900 E Airport Rd, Box 1118 OKMULGEE |
| State: | OK |
| Postal Code: | 744479082 |
| Phone Number: | 9187569211 |
| Fax Number: | 9187569452 |
| NPI Enumeration Date: | 06/30/2005 |
| NPI Last Update Date: | 09/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 2265 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |