Individual
BLAKE ANDREW SHUPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AOD COUNSELOR
Contact information
Practice address
201 BRUSH ST, UKIAH, CA 95482-3424
(707) 462-6290
Mailing address
2365 ROAD E, REDWOOD VALLEY, CA 95470-9517
(707) 462-6290
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
7581
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7581
CADTP
CA
Enumeration date
09/11/2018
Last updated
09/11/2018
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