Provider Demographics
NPI:1720243355
Name:BLANEY, MICHAEL (LMFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BLANEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:BLANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCC
Mailing Address - Street 1:413 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:413 SPRING ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3848
Practice Address - Country:US
Practice Address - Phone:423-756-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA748106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist