Provider Demographics
NPI:1285177121
Name:BLANK, STEVEN M (LMFT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:BLANK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 N BLACKHAWK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3357
Mailing Address - Country:US
Mailing Address - Phone:608-663-5926
Mailing Address - Fax:608-663-5928
Practice Address - Street 1:702 N BLACKHAWK AVE STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3357
Practice Address - Country:US
Practice Address - Phone:608-663-5926
Practice Address - Fax:608-663-5928
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-27
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist