Individual
BLAKELY SJOSTEDT WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4119 TANAGER ST, FORT COLLINS, CO 80526-3687
(970) 308-9733
Mailing address
4119 TANAGER ST, FORT COLLINS, CO 80526-3687
(813) 728-7420
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LSW.0009922792
CO
101YM0800X
Mental Health Counselor
Primary
CSW.0009922792
CO
Other
Enumeration date
06/15/2020
Last updated
03/30/2022
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