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General NPI Number Information
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NPI Number | 1235855115
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Entity Type | Individual
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Provider Name | BROOKE NAOMI BLANKENSHIP LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 5215 N RAVENSWOOD AVE STE 208
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City | CHICAGO
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State | IL
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Zip | 60640-1670
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Country | US
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Telephone | 219-309-6203
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Fax |
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Provider Business Mailing Address
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Address Line | 846 W AINSLIE ST APT RC
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City | CHICAGO
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State | IL
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Zip | 60640-7369
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Country | US
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Telephone | 219-309-6203
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.014180
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License Number State | IL
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