Blake, Mistey Lynn

Blake, Mistey Lynn is an individual health care provider with primary practice located at 50430 School House Rd 100, Canton MI 48187-5910. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Blake, Mistey Lynn can be contacted via phone (734) 495-1722.

Contact Information

Primary practice address
50430 School House Rd 100 Canton MI 48187-5910
Phone: (734) 495-1722
Fax: (734) 495-3068
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 6301015297 Michigan

Profile Details

NPI number 1821330499
LBN Legal business name Blake, Mistey Lynn
Credentials MA TLLP CADC-M
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 21st, 2013
Last updated Mar 21st, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821330499 NPPES
Michigan MEDICAID 213119549

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