Provider Demographics
NPI:1700424850
Name:BLACKSTONE, GUY (LPC, CRC)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:
Last Name:BLACKSTONE
Suffix:
Gender:M
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:GUY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4351 DONCASTER DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-3717
Mailing Address - Country:US
Mailing Address - Phone:181-598-1263
Mailing Address - Fax:
Practice Address - Street 1:2961 YARMOUTH GREENWAY DR STE 2
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5809
Practice Address - Country:US
Practice Address - Phone:608-504-3600
Practice Address - Fax:608-504-3700
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4546-226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor