Provider Demographics
NPI:1508990136
Name:BLAKE, MICHELLE EMERY (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:EMERY
Last Name:BLAKE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 DUNBAR CAVE RD STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8831
Mailing Address - Country:US
Mailing Address - Phone:651-313-8080
Mailing Address - Fax:812-488-2282
Practice Address - Street 1:223 DUNBAR CAVE RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8830
Practice Address - Country:US
Practice Address - Phone:651-313-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-20811041C0700X
IN34004767A1041C0700X
TN81601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical