| Doctor Name: | JOHN ALAN BLACK |
| NPI Number: | 1225330277 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 4135 |
| Business Practice Address: | 107 S High St Antlers, OK - 745233818 |
| Business Phone Number: | 5802982830 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1030, ANTLERS |
| State: | OK |
| Postal Code: | 745231030 |
| Phone Number: | 5802982830 |
| Fax Number: | |
| NPI Enumeration Date: | 11/24/2010 |
| NPI Last Update Date: | 09/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 4135 |
| 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 |