Provider Demographics
NPI:1548563539
Name:BLAKELY, CAROL (BA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:BLAKELY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 W. TROPICANA
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4755
Mailing Address - Country:US
Mailing Address - Phone:702-209-0370
Mailing Address - Fax:702-463-1851
Practice Address - Street 1:6767 W. TROPICANA
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4755
Practice Address - Country:US
Practice Address - Phone:702-209-0370
Practice Address - Fax:702-463-1851
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker