Provider Demographics
NPI:1578906053
Name:RINGENBERG, BLAKE WILLIAM (LPC)
Entity Type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:WILLIAM
Last Name:RINGENBERG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 MILTON GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-8639
Mailing Address - Country:US
Mailing Address - Phone:717-312-8470
Mailing Address - Fax:
Practice Address - Street 1:1502 MILTON GROVE RD
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552
Practice Address - Country:US
Practice Address - Phone:717-342-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008877101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor