DR BLAKE BAZEL PHD PA
Social Work at Wells Rd, Orange Park, FL

License number
Florida PY 8593
Category
Social Work
Type
Clinical
Owner
Name: DR. BLAKE BAZEL PHD
Title: PSYCHOLOGIST
Phone: (904) 272-0043
Address
Address
1677 Wells Rd SUITE A, Orange Park, FL 32073
National Provider ID: 1467792697
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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DR. BLAKE BAZEL, PH.D., PA

1677 Wl Rd SUITE A, Orange Park, FL 32073

Registration:
Feb 27, 2013
State ID:
P13000019164
Business type:
Florida Profit Corporation
President:
Blake Ph.d. Bazel (President), 1677 Wl Rd, Orange Park, FL 32073 (Physical)
Agent:
Blake Bazel,1677 Wl Rd SUITE A, Orange Park, FL 32073 (Physical)
EIN:
46-2149766

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