Active NPI
Marcy Blake
- Professional Counselor
- Richardson, TX
National Provider Identifier
1245338680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 19616
- Practice address
- 2150 Lakeside Blvd
Suite 100
Richardson, TX 75082-4302 - Phone
- (972) 437-4698
- Fax
- (972) 690-9309
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 19616 | TX | Primary |
Addresses
Primary practice location
2150 Lakeside Blvd
Suite 100
Richardson, TX 75082-4302
Mailing address
2150 Lakeside Blvd
Suite 100
Richardson, TX 75082-4302
Phone (972) 437-4698
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 13, 2024 through Jun 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19616 | TX | MD | Music Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408406400000",
"number": "1245338680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2150 LAKESIDE BLVD",
"address_2": "SUITE 100",
"city": "RICHARDSON",
"state": "TX",
"postal_code": "750824302",
"telephone_number": "972-437-4698",
"fax_number": "972-690-9309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2150 LAKESIDE BLVD",
"address_2": "SUITE 100",
"city": "RICHARDSON",
"state": "TX",
"postal_code": "750824302",
"telephone_number": "972-437-4698",
"fax_number": "972-690-9309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKE",
"first_name": "MARCY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2014-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "19616",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richardson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2014; 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.