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NPI Code Detail

MEDICARE: DR. MICHELLE EMERY BLAKE PH.D, LCSW

MEDICARE: DR. MICHELLE EMERY BLAKE PH.D, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerKY-2081KY
21041C0700XClinical Social Worker34004767AIN
31041C0700XClinical Social Worker8160TN

General Provider Information

NPI Number : 1508990136
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHELLE EMERY BLAKE PH.D, LCSW
Provider Business Mailing Address
First Line : 223 DUNBAR CAVE RD STE A
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37043-8831
Country : US
Telephone Number : 651-313-8080
Fax Number : 812-488-2282
Provider Business Practice Location Address
First Line : 223 DUNBAR CAVE RD
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37043-8830
Country : US
Telephone Number : 651-313-8080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 08/25/2023

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