Provider Demographics
NPI:1871031997
Name:BLAKE HEALING FOR YOU PLLC
Entity Type:Organization
Organization Name:BLAKE HEALING FOR YOU PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:760-641-4408
Mailing Address - Street 1:3530 1ST AVE N
Mailing Address - Street 2:SUITE 217
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8435
Mailing Address - Country:US
Mailing Address - Phone:760-641-4408
Mailing Address - Fax:727-954-7190
Practice Address - Street 1:3530 1ST AVE N
Practice Address - Street 2:SUITE 217
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8435
Practice Address - Country:US
Practice Address - Phone:760-641-4408
Practice Address - Fax:727-954-7190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8077251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15620200Medicaid