Individual
BLAKE BAZEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1677 WELLS RD, SUITE A, ORANGE PARK, FL 32073-6799
(904) 272-0043
Mailing address
1677 WELLS RD, SUITE A, ORANGE PARK, FL 32073-6799
(904) 272-0043
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY8593
FL
Other
Enumeration date
09/14/2012
Last updated
02/26/2013
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