Provider Information for 1225361231
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MARCIA T BLAKE LPC
Sex: Female
NPI: 1225361231
Last Updated: 2024-05-31
Certification Date: 2024-05-31
Certification Date: 2024-05-31
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1225361231 | ||||||||||||
| Enumeration Date | 2009-09-09 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 7320 PARKRIDGE BLVD APT 67 IRVING, TX 75063-8349 United States Phone: 616-558-9343 | Fax: | ||||||||||||
| Primary Practice Address | 7320 PARKRIDGE BLVD APT 67 IRVING, TX 75063-8349 United States Phone: 616-558-9343 | Fax: | ||||||||||||
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