Provider Demographics
NPI:1942818323
Name:ASHLEY BLAKE, LCSW LLC
Entity Type:Organization
Organization Name:ASHLEY BLAKE, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-315-1491
Mailing Address - Street 1:7750 CLAYTON RD STE 107
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1343
Mailing Address - Country:US
Mailing Address - Phone:314-485-7344
Mailing Address - Fax:
Practice Address - Street 1:7750 CLAYTON RD STE 107
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1343
Practice Address - Country:US
Practice Address - Phone:314-485-7344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health