Individual
KEVIN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PC
Contact information
Practice address
4400 EUCLID AVE, CLEVELAND, OH 44103-3734
(216) 432-7200
(216) 432-7253
Mailing address
4500 EUCLID AVE, CLEVELAND, OH 44103-3736
(216) 432-7200
(216) 432-7253
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
C1300277
OH
101YP2500X
Professional Counselor
Primary
E.1800638
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C1300277
STATE LICENSE
OH
Enumeration date
01/19/2016
Last updated
03/23/2020
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