Provider Demographics
NPI:1134597172
Name:BLANKENSHIP, JACQUELINE M (LPC, ATR)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:M
Other - Last Name:YURIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4105 MONROEVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2607
Mailing Address - Country:US
Mailing Address - Phone:412-380-0100
Mailing Address - Fax:
Practice Address - Street 1:101 PEMBROKE CT
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6404
Practice Address - Country:US
Practice Address - Phone:724-396-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008382101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional