Individual
DR. TERESA JANE BLAKELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
275 E LONGVIEW AVE, COLUMBUS, OH 43202-1239
(614) 262-8317
(614) 262-5609
Mailing address
275 E LONGVIEW AVE, COLUMBUS, OH 43202-1239
(614) 262-8317
(614) 262-5609
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3470
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
401660
VALUE OPTIONS PROVIDER ID
OH
Enumeration date
05/12/2006
Last updated
12/06/2024
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