Doctor Name: | DR. KEVIN BLAKLEY |
NPI Number: | 1295794147 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSY.D. |
License Number: | 1742 |
Business Practice Address: | 5955 Zeamer Ave Elmendorf Afb, AK - 995063702 |
Business Phone Number: | 9075803114 |
Business Fax Number: | |
Mailing Address: | 5955 Zeamer Ave, ELMENDORF AFB |
State: | AK |
Postal Code: | 995063702 |
Phone Number: | 9075803114 |
Fax Number: | |
NPI Enumeration Date: | 03/20/2006 |
NPI Last Update Date: | 02/11/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 1742 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |