Provider Demographics
NPI:1427552140
Name:BLACKMER, BRITTANY KAYE
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:KAYE
Last Name:BLACKMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10793 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:FIFE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49633-9069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1363 DOUGLAS DR STE 104
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49696-8980
Practice Address - Country:US
Practice Address - Phone:231-668-4909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician