Healthcare Provider Details

I. General information

NPI: 1194103150
Provider Name (Legal Business Name): TAMMY L. BLAKENEY LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 TRESCOTT LN
SOUTH ROYALTON VT
05068-9426
US

IV. Provider business mailing address

126 TRESCOTT LN
SOUTH ROYALTON VT
05068-9426
US

V. Phone/Fax

Practice location:
  • Phone: 603-336-3852
  • Fax:
Mailing address:
  • Phone: 603-336-3852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1164
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number068.0094515
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: