Individual
TINA MARIE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
1024 CENTRE AVE BLDG E, SUITE 200, FORT COLLINS, CO 80526-1887
(970) 224-2080
Mailing address
1024 CENTRE AVE BLDG E, SUITE 200, FORT COLLINS, CO 80526-1887
(970) 224-2080
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
489
CO
Other
Enumeration date
06/20/2007
Last updated
01/28/2013
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