Provider Demographics
NPI:1346697018
Name:FEAGANS, BLAKE (MA, LPC-MHSP)
Entity Type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:
Last Name:FEAGANS
Suffix:
Gender:M
Credentials:MA, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 GEORGIA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2073
Mailing Address - Country:US
Mailing Address - Phone:423-708-4365
Mailing Address - Fax:
Practice Address - Street 1:707 GEORGIA AVE STE 203
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2073
Practice Address - Country:US
Practice Address - Phone:423-708-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN5105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health