Provider Demographics
NPI:1356497556
Name:BLEA, PHILLIP FRANCIS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:FRANCIS
Last Name:BLEA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:PHILLIP
Other - Middle Name:FRANCIS
Other - Last Name:BLEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3570 ELDERBERRY DR S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4053
Mailing Address - Country:US
Mailing Address - Phone:503-587-0555
Mailing Address - Fax:
Practice Address - Street 1:4455 NE HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-9695
Practice Address - Country:US
Practice Address - Phone:541-750-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR34511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTFS001CFHOtherLCSW