Provider Demographics
NPI:1861975187
Name:BLAKELEY, CAREY COLLEEN (MS, LPC, RPT)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:COLLEEN
Last Name:BLAKELEY
Suffix:
Gender:F
Credentials:MS, LPC, RPT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:BLAKELEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC, RPT
Mailing Address - Street 1:910 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2831
Mailing Address - Country:US
Mailing Address - Phone:903-957-0440
Mailing Address - Fax:
Practice Address - Street 1:910 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2831
Practice Address - Country:US
Practice Address - Phone:903-957-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76999101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health