Blake Kelly Earl

NPI #1578805214 in South Ogden, Utah

Provider Information

NPI Number: 1578805214
Entity Type: Individual
Name: Blake Kelly Earl
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor
Enumeration Date: Mar 20, 2013
Last Updated: Mar 20, 2013

Practice Location

Address: 5150 S. WASHINGTON BLVD.
Address 2: SUITE 1
City: South Ogden
State: Utah
ZIP Code: 84405-4503
Phone: (801) 337-0067

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary

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