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MISTEY LYNN BLAKE MA TLLP CADC-M
NPI 1821330499
Psychologist - Clinical in Canton, MI

Active since March 21, 2013
50430 SCHOOL HOUSE RD, 100, CANTON, MI 48187(734) 495-1722(734) 495-3068 Get Directions Write a Review

NPPES record last updated: March 21, 2013. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Mistey Lynn Blake Ma Tllp Cadc-m NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISTEY LYNN BLAKE MA TLLP CADC-M (NPI 1821330499) is an individual clinical provider in Canton, Michigan, licensed in Michigan (6301015297) and active in the NPI registry since March 2013.

NPPES Registry Identity

NPI1821330499
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameMISTEY LYNN BLAKECredential: MA TLLP CADC-M
Location Address50430 SCHOOL HOUSE RD, 100Canton, MI 48187-5910
Mailing Address50430 School House Rd, 100Canton, MI 48187-5910 · (734) 495-1722 · Fax (734) 495-3068
Phone(734) 495-1722
Fax(734) 495-3068
Sole ProprietorNo
Enumeration DateMarch 21, 2013
✔ NPI 1821330499 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in MI · 6301015297
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
50430 SCHOOL HOUSE RD, Canton, MI 48187
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Other Identifiers 1

Medicaid213119549MI

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JANICE TOPOREK
Counselor (Addiction (Substance Use Disorder))
50430 SCHOOL HOUSE RD
CANTON, MI 48187
Wayne County (734) 495-1722
WILLIAM CARROLL
Peer Specialist
50430 SCHOOL HOUSE RD
CANTON, MI 48187
Wayne County (734) 589-7974
MISS MARIN KOLASA
Peer Specialist
50430 SCHOOL HOUSE RD
CANTON, MI 48187
Wayne County (734) 495-1722
MR. NATHANIEL EDISON PONDER LMSW, CCS, CADC
Social Worker (Clinical)
50430 SCHOOL HOUSE RD
CANTON, MI 48187
Wayne County (734) 495-1722
MARY BLACKMON CPRC
Counselor (Addiction (Substance Use Disorder))
50430 SCHOOL HOUSE RD
CANTON, MI 48187
Wayne County (734) 431-2357
KIRSTEN COLLEEN KELLY CPRC
Peer Specialist
50430 SCHOOL HOUSE RD
CANTON, MI 48187
Wayne County (248) 329-8954
NASHAWN DEAN RUSSEL LARIVIERE CPRC
Counselor (Addiction (Substance Use Disorder))
50430 SCHOOL HOUSE RD
CANTON, MI 48187
Wayne County (734) 495-1722
ROBERT WIEDEMANN
Peer Specialist
50430 SCHOOL HOUSE RD
CANTON, MI 48187
Wayne County (734) 495-1722

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mistey Blake's NPI number?

The NPI number for Mistey Blake is 1821330499. It was assigned to this individual provider in the NPPES registry on March 21, 2013.

Where is Mistey Blake located?

Mistey Blake practices at 50430 School House Rd 100, Canton, MI 48187. The listed phone number is (734) 495-1722.

What is Mistey Blake's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

When was this NPI record last updated?

The NPPES record for Mistey Blake was last updated on March 21, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.