Provider Demographics
NPI:1518905132
Name:BLAKELY, MARGARET LIPHAM (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:MARGARET
Middle Name:LIPHAM
Last Name:BLAKELY
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Gender:F
Credentials:MED, LPC
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Mailing Address - Street 1:3212 COLLINSWORTH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6580
Mailing Address - Country:US
Mailing Address - Phone:817-877-3707
Mailing Address - Fax:817-810-9585
Practice Address - Street 1:3212 COLLINSWORTH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6580
Practice Address - Country:US
Practice Address - Phone:817-877-3707
Practice Address - Fax:817-810-9585
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX10723101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional