Individual
KECIA MARIE BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPSY, LMHC
Contact information
Practice address
52189 SCOTT ST, SOUTH BEND, IN 46637-2952
(574) 208-3359
(866) 812-9889
Mailing address
1143 E IRELAND RD # 1003, SOUTH BEND, IN 46614-3446
(574) 208-3359
(866) 812-9889
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39004492A
IN
Other
Enumeration date
06/17/2010
Last updated
04/20/2023
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