Individual
DR. MATTHEW THOMAS BLAKELEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
8495 CRATER LAKE HWY, WHITE CITY, OR 97503-3011
(541) 826-2111
Mailing address
8495 CRATER LAKE HWY, WHITE CITY, OR 97503-3011
(541) 826-2111
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2009010489
MO
Other
Enumeration date
03/07/2011
Last updated
03/07/2011
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