Individual
ELIZABETH BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3412 S 49TH AVE, OMAHA, NE 68106-4010
(402) 212-0497
Mailing address
3412 S 49TH AVE, OMAHA, NE 68106-4010
(402) 212-0497
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
10891
NE
Other
Enumeration date
07/11/2016
Last updated
07/11/2016
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