Provider Demographics
NPI:1265781579
Name:SUZELIS, BLAKE (LMHC)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:SUZELIS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 ASPEN SHORES DR
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-5870
Mailing Address - Country:US
Mailing Address - Phone:330-307-4460
Mailing Address - Fax:
Practice Address - Street 1:330 KING ST STE 5
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2857
Practice Address - Country:US
Practice Address - Phone:509-881-4059
Practice Address - Fax:833-879-7547
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60691506101YM0800X
OHC.1200592101YP2500X
WALH60815437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional