Provider Demographics
NPI:1568515989
Name:BLEAKMORE, CHARLES FRANKLIN (MA COUNSELING PSYCHO)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:FRANKLIN
Last Name:BLEAKMORE
Suffix:
Gender:M
Credentials:MA COUNSELING PSYCHO
Other - Prefix:
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Mailing Address - Street 1:630 MALLARD DRIVE
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-1066
Mailing Address - Country:US
Mailing Address - Phone:614-890-4166
Mailing Address - Fax:614-436-1194
Practice Address - Street 1:77 E WILSON BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2324
Practice Address - Country:US
Practice Address - Phone:614-436-1188
Practice Address - Fax:614-436-1194
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHE-718101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health