Individual
INDIA BLAKELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
17337 WOODED PATH DR APT 3S, EAST HAZEL CREST, IL 60429-2619
(708) 805-9380
Mailing address
18300 S. HALSTED, SUITE B MAILBOX 107, GLENWOOD, IL 60425
(312) 736-2060
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
180007413
IL
Other
Enumeration date
09/27/2020
Last updated
09/27/2020
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