| Kecia Blakely, Msp, Lmhc | |
|
52189 Scott St South Bend IN 46637 | |
| (574) 208-3359 | |
| Not Available |
| Full Name | Kecia Blakely, Msp, Lmhc |
|---|---|
| Speciality | Counselor |
| Location | 52189 Scott St, South Bend, Indiana |
| Authorized Official Name and Position | Kecia Marie Blakely (OWNER) |
| Authorized Official Contact | 5748009681 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kecia Blakely, Msp, Lmhc 52189 Scott St South Bend IN 46637-2952 Ph: (574) 800-9681 | Kecia Blakely, Msp, Lmhc 52189 Scott St South Bend IN 46637 Ph: (574) 208-3359 |
| NPI Number | 1598446395 |
|---|---|
| Provider Enumeration Date | 07/26/2023 |
| Last Update Date | 09/03/2024 |
| Certification Date | 09/03/2024 |
| Medicare PECOS PAC ID | 8820538069 |
|---|---|
| Medicare Enrollment ID | O20240913002461 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598446395 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kecia Marie Blakely |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750602355 PECOS PAC ID: 9739629973 Enrollment ID: I20240913002567 |
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