Provider Demographics
NPI:1881075794
Name:BLYTHE, CHA'LEE
Entity type:Individual
Prefix:MR
First Name:CHA'LEE
Middle Name:
Last Name:BLYTHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7420 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1611
Mailing Address - Country:US
Mailing Address - Phone:561-316-6132
Mailing Address - Fax:561-316-6132
Practice Address - Street 1:7420 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1611
Practice Address - Country:US
Practice Address - Phone:561-316-6132
Practice Address - Fax:561-316-6132
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst