Provider Demographics
NPI:1538763818
Name:BLAKE SUZELIS HOLISTIC COUNSELORS, LLP
Entity type:Organization
Organization Name:BLAKE SUZELIS HOLISTIC COUNSELORS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUZELIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:509-879-9069
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:509-879-9069
Mailing Address - Fax:833-879-7547
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty