Provider Demographics
NPI:1548975048
Name:BLAKELEY, ALECIA ELAINE
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:ELAINE
Last Name:BLAKELEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1764 BRIGHAM YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3085
Mailing Address - Country:US
Mailing Address - Phone:307-680-8227
Mailing Address - Fax:
Practice Address - Street 1:2345 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2048
Practice Address - Country:US
Practice Address - Phone:307-333-1301
Practice Address - Fax:307-333-5436
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1360101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor