Blakely Sjostedt Williams, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CSW.0009922792 Issued in CO

Practice address

4119 Tanager St
Fort Collins, CO 80526-3687

Phone

(970) 308-9733

NPI assigned

Jun 15, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 20, 2024 through Feb 20, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1144845298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4119 TANAGER ST",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805263687",
            "telephone_number": "813-728-7420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4119 TANAGER ST",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805263687",
            "telephone_number": "970-308-9733"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 W Olive St",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805212716",
            "country_code": "US",
            "telephone_number": "970-308-9733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "BLAKELY",
        "middle_name": "SJOSTEDT",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-15",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CO",
            "license": "LSW.0009922792",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "CSW.0009922792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Travis R Willey, D.D.S.
• William J Thieman MD PC
• Lisa N William, BSW
• Kathy Williams-Tolstrup, M.ED.
• Amanda Williams, RDH, OMT
• Brian Williams Jr., MA
• Carl A Williams, LCSW
• Christopher Scott Williams, MACP, LAC
• David Williams
• Elizabeth D Williams, LCSW

• Mental Health Counselor in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Mental Health Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.