Individual
DR. HAROLD HERBERT BLAKELOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1836 N 1120 W # 2, PROVO, UT 84604-1179
(801) 722-8362
Mailing address
1836 N 1120 W # 2, PROVO, UT 84604-1179
(801) 722-8362
Taxonomy
Speciality
Code
Description
License number
State
103TF0200X
Forensic Psychologist
Primary
114279-2501
UT
Other
Enumeration date
08/06/2012
Last updated
08/06/2012
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