Provider Demographics
NPI:1053520163
Name:BLAIR, ALYSON SHEA (LADC, LPC)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:SHEA
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LADC, LPC
Other - Prefix:MISS
Other - First Name:ALYSON
Other - Middle Name:SHEA
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA,LADC,LPC
Mailing Address - Street 1:415 WINDING LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5129
Mailing Address - Country:US
Mailing Address - Phone:405-203-8285
Mailing Address - Fax:
Practice Address - Street 1:501 N MUSTANG RD
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-7048
Practice Address - Country:US
Practice Address - Phone:405-203-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5072101YP2500X
OK931101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)