Provider Demographics
NPI:1124167960
Name:BLASDEL, ROBERT WESTON (MS, LADC,LMFT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WESTON
Last Name:BLASDEL
Suffix:
Gender:M
Credentials:MS, LADC,LMFT
Other - Prefix:MR
Other - First Name:BOB
Other - Middle Name:WESTON
Other - Last Name:BLASDEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,LADC,LMFT
Mailing Address - Street 1:700 SW PENN AVE.
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-7923
Mailing Address - Country:US
Mailing Address - Phone:918-333-5861
Mailing Address - Fax:
Practice Address - Street 1:700 SW PENN AVE.
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-7923
Practice Address - Country:US
Practice Address - Phone:918-333-5861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK373106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist