Individual
CARL C BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
12163 SOUTH PERRY PARK ROAD, LARKSPUR, CO 80118
(303) 681-2400
(303) 681-2401
Mailing address
14142 DENVER WEST PKWY, SUITE 225, LAKEWOOD, CO 80401-3189
(303) 237-6865
(303) 237-6873
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC 4701
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78732069
—
CO
Enumeration date
04/03/2007
Last updated
07/09/2007
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