| Doctor Name: | WANDA A BLACKWELL |
| NPI Number: | 1740350396 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, LPC |
| License Number: | LPC #3140 |
| Business Practice Address: | 1131 N Kickapoo Ave Shawnee, OK - 748014845 |
| Business Phone Number: | 4052752877 |
| Business Fax Number: | 4052752877 |
| Mailing Address: | Po Box 3, MORRIS |
| State: | OK |
| Postal Code: | 744450003 |
| Phone Number: | 9187339486 |
| Fax Number: | |
| NPI Enumeration Date: | 11/09/2006 |
| NPI Last Update Date: | 02/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | LPC #3140 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |