Healthcare Provider Details

I. General information

NPI: 1396953691
Provider Name (Legal Business Name): MIKE L BLAKEY PSY. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 11/16/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W. BENSON BLVD STE 315
ANCHORAGE AK
99503
US

IV. Provider business mailing address

P.O. BOX 111810
ANCHORAGE AK
99511
US

V. Phone/Fax

Practice location:
  • Phone: 907-929-4009
  • Fax: 907-929-4902
Mailing address:
  • Phone: 907-929-4009
  • Fax: 907-929-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number113993
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: