Provider Demographics
NPI:1942022009
Name:BLANTON, BAYLEE RAY (LMHCA)
Entity type:Individual
Prefix:
First Name:BAYLEE
Middle Name:RAY
Last Name:BLANTON
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 S ORCHARD ST APT D204
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-2423
Mailing Address - Country:US
Mailing Address - Phone:325-660-7349
Mailing Address - Fax:
Practice Address - Street 1:33400 9TH AVE S STE 100
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-2607
Practice Address - Country:US
Practice Address - Phone:206-567-7267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61453648101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health