Provider Demographics
NPI:1124160106
Name:BLAKE, DONNA H (PSYCHOTHERAPIST)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:H
Last Name:BLAKE
Suffix:
Gender:F
Credentials:PSYCHOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5210 E PIMA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3664
Mailing Address - Country:US
Mailing Address - Phone:520-795-9313
Mailing Address - Fax:520-777-5768
Practice Address - Street 1:5210 E PIMA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3664
Practice Address - Country:US
Practice Address - Phone:520-795-9313
Practice Address - Fax:520-777-5768
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2013-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC2202101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1124160106OtherNATIONAL PROVIDER IDENTIFIER