Provider Demographics
NPI:1326470253
Name:BLAKELY, CASSANDRA SUE (PLMHP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:SUE
Last Name:BLAKELY
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 F ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-3253
Mailing Address - Country:US
Mailing Address - Phone:402-469-2023
Mailing Address - Fax:
Practice Address - Street 1:2910 F ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-3253
Practice Address - Country:US
Practice Address - Phone:402-469-2023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health