Provider Demographics
NPI:1497240543
Name:BLAKELY HARPER LCSW PC
Entity Type:Organization
Organization Name:BLAKELY HARPER LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BLAKELY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:229-333-0300
Mailing Address - Street 1:12 SWEET GUM TRL
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8498
Mailing Address - Country:US
Mailing Address - Phone:229-333-0300
Mailing Address - Fax:229-333-0306
Practice Address - Street 1:3350 NOBLE WAY STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7444
Practice Address - Country:US
Practice Address - Phone:229-333-0300
Practice Address - Fax:229-333-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)