Provider Demographics
NPI:1043644891
Name:BLAKE, JANELLE HERMA
Entity Type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:HERMA
Last Name:BLAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JANELLE
Other - Middle Name:HERMA
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAC III
Mailing Address - Street 1:7290 SAMUEL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-2743
Mailing Address - Country:US
Mailing Address - Phone:303-487-7776
Mailing Address - Fax:303-487-7868
Practice Address - Street 1:7290 SAMUEL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2743
Practice Address - Country:US
Practice Address - Phone:303-487-7776
Practice Address - Fax:303-487-7868
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO635101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)