| Lisa Blake Therapy | |
|
4933 S 1500 W Ste 200 Riverdale UT 84405-7738 | |
| (801) 695-5057 | |
| Not Available |
| Full Name | Lisa Blake Therapy |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4933 S 1500 W Ste 200, Riverdale, Utah |
| Authorized Official Name and Position | Lisa Blake (OWNER) |
| Authorized Official Contact | 8016955057 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Blake Therapy 1314 24th St Ogden UT 84401-2902 Ph: (801) 695-5057 | Lisa Blake Therapy 4933 S 1500 W Ste 200 Riverdale UT 84405-7738 Ph: (801) 695-5057 |
| NPI Number | 1063124451 |
|---|---|
| Provider Enumeration Date | 12/19/2022 |
| Last Update Date | 12/19/2022 |
| Certification Date | 12/17/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063124451 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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