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General NPI Number Information
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NPI Number | 1942818323
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Entity Type | Organization
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Legal Business Name | ASHLEY BLAKE, LCSW LLC
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 7750 CLAYTON RD STE 107
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-1343
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Country | US
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Telephone | 314-485-7344
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Fax |
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Provider Business Mailing Address
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Address Line | 7750 CLAYTON RD STE 107
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-1343
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Country | US
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Telephone | 314-485-7344
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | ASHLEY BLAKE
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Credential | LCSW
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Telephone | 773-315-1491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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