Provider Demographics
NPI:1265187553
Name:BLANKMAN, MELISSA A (COUNSELOR)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BLANKMAN
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-3002
Mailing Address - Country:US
Mailing Address - Phone:765-430-2815
Mailing Address - Fax:
Practice Address - Street 1:4705 MEIJER CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4684
Practice Address - Country:US
Practice Address - Phone:765-701-6060
Practice Address - Fax:765-701-6061
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)