Individual
MICHELLE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC ASSOCIATE
Contact information
Practice address
9594 S STATE HIGHWAY 34, SCURRY, TX 75158-3146
(469) 212-5552
Mailing address
9594 S STATE HIGHWAY 34, SCURRY, TX 75158-3146
(469) 212-5552
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
82408
TX
Other
Enumeration date
09/29/2021
Last updated
09/29/2021
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