Provider Demographics
NPI:1699278820
Name:STEAGALL, BLAKE D (LPC)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:D
Last Name:STEAGALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47701-0033
Mailing Address - Country:US
Mailing Address - Phone:812-402-8333
Mailing Address - Fax:812-402-8331
Practice Address - Street 1:15 VANN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1444
Practice Address - Country:US
Practice Address - Phone:812-402-8333
Practice Address - Fax:812-402-8331
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007564101YM0800X
IN39003613A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty