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Individual
MRS. TRICIA BLAKELY
Active
Individual
MRS. TRICIA BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34004432A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000336982
BLUE CROSS BLUE SHIELD
IN
01
—
740963000
MAGELLAN
IN
Enumeration date
03/07/2007
Last updated
11/25/2014
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