Healthcare Provider Details

I. General information

NPI: 1942818323
Provider Name (Legal Business Name): ASHLEY BLAKE, LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 CLAYTON RD STE 107
RICHMOND HEIGHTS MO
63117-1343
US

IV. Provider business mailing address

7750 CLAYTON RD STE 107
RICHMOND HEIGHTS MO
63117-1343
US

V. Phone/Fax

Practice location:
  • Phone: 314-485-7344
  • Fax:
Mailing address:
  • Phone: 314-485-7344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY BLAKE
Title or Position: ORGANIZER
Credential: LCSW
Phone: 773-315-1491