Provider Demographics
NPI:1851814230
Name:LOW, BLAKELY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BLAKELY
Middle Name:
Last Name:LOW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4856 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-7896
Mailing Address - Country:US
Mailing Address - Phone:210-885-2393
Mailing Address - Fax:
Practice Address - Street 1:1229 MEADOW STREET SUITE #221
Practice Address - Street 2:JONES FAMILY CENTER FOR STUDENT-ATHLETE SUCCESS
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:210-885-2393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist