Healthcare Provider Details

I. General information

NPI: 1396256665
Provider Name (Legal Business Name): MICHELLE M BLAKELEY MFT, CPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 E LAKE MEAD PKWY STE 2
HENDERSON NV
89015-5573
US

IV. Provider business mailing address

519 FIFE ST
HENDERSON NV
89015-4648
US

V. Phone/Fax

Practice location:
  • Phone: 702-907-8306
  • Fax: 702-907-8306
Mailing address:
  • Phone: 702-907-8306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4154
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5066
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: