| Doctor Name: | CARLY BLEMMEL |
| NPI Number: | 1194116715 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BA |
| License Number: | |
| Business Practice Address: | 13597 Se 202nd Rd Talihina, OK - 745716003 |
| Business Phone Number: | 9185672905 |
| Business Fax Number: | |
| Mailing Address: | Po Box 740, TALIHINA |
| State: | OK |
| Postal Code: | 745710740 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/18/2015 |
| NPI Last Update Date: | 02/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 324500000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |