Provider Information for 1508990136
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Dr. MICHELLE EMERY BLAKE Ph.D, LCSW
Sex: Female
NPI: 1508990136
Last Updated: 2023-08-25
Certification Date: 2023-08-25
Certification Date: 2023-08-25
Details
| Name | Value | ||||||||||||||||
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| NPI | 1508990136 | ||||||||||||||||
| Enumeration Date | 2007-03-15 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 223 DUNBAR CAVE RD STE A CLARKSVILLE, TN 37043-8831 United States Phone: 651-313-8080 | Fax:812-488-2282 | ||||||||||||||||
| Primary Practice Address | 223 DUNBAR CAVE RD CLARKSVILLE, TN 37043-8830 United States Phone: 651-313-8080 | Fax: | ||||||||||||||||
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