Provider Demographics
NPI:1427090950
Name:BLAKESLEE, PATRICIA A (LMFT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:BLAKESLEE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-2535
Mailing Address - Country:US
Mailing Address - Phone:386-562-2675
Mailing Address - Fax:
Practice Address - Street 1:430 BRADDOCK AVE
Practice Address - Street 2:PRESBYTERIAN COUNSELING CENTER
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-4616
Practice Address - Country:US
Practice Address - Phone:386-258-1616
Practice Address - Fax:386-253-4215
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1102106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist