Healthcare Provider Details

I. General information

NPI: 1700741196
Provider Name (Legal Business Name): TAYLOR RAE BLAKLEY LMHC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 N EAST ST
GREENFIELD IN
46140-2167
US

IV. Provider business mailing address

28 N EAST ST
GREENFIELD IN
46140-2167
US

V. Phone/Fax

Practice location:
  • Phone: 317-649-4311
  • Fax:
Mailing address:
  • Phone: 317-649-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88002698A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: