Individual
MS. BLAKE ANN KISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2504 CAMINO ENTRADA, SANTA FE, NM 87507-4851
(505) 216-2727
Mailing address
2504 CAMINO ENTRADA BLDG B, SANTA FE, NM 87507-4851
(505) 216-2727
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CTB-2024-0290
NM
Other
Enumeration date
10/24/2019
Last updated
12/19/2024
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