Individual
KEVIN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PC
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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