Provider Demographics
NPI:1659052355
Name:BLAKE, LINDSEY (LLPC, NCC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64541 VAN DYKE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48095-2570
Mailing Address - Country:US
Mailing Address - Phone:248-543-0033
Mailing Address - Fax:
Practice Address - Street 1:64541 VAN DYKE RD STE 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48095-2570
Practice Address - Country:US
Practice Address - Phone:248-543-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451024030101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor