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General NPI Number Information
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NPI Number | 1598446395
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Entity Type | Organization
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Legal Business Name | KECIA BLAKELY, MSP, LMHC
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 52189 SCOTT ST
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City | SOUTH BEND
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State | IN
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Zip | 46637
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Country | US
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Telephone | 574-208-3359
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Fax |
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Provider Business Mailing Address
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Address Line | 52189 SCOTT ST
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City | SOUTH BEND
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State | IN
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Zip | 46637-2952
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Country | US
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Telephone | 574-800-9681
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KECIA MARIE BLAKELY
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Credential | LMHC
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Telephone | 574-800-9681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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