Individual
KATHLEEN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13322 I ST, OMAHA, NE 68137-1111
(402) 230-5861
(531) 200-5808
Mailing address
13322 I ST, OMAHA, NE 68137-1111
(402) 230-5861
(531) 200-5808
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3113
NE
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
08/08/2019
Last updated
09/29/2022
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