Provider Demographics
NPI:1326404955
Name:FREY, BLAKE GREGORY (MA)
Entity Type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:GREGORY
Last Name:FREY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 NE 77TH AVE STE 275
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6857
Mailing Address - Country:US
Mailing Address - Phone:360-685-1597
Mailing Address - Fax:360-249-9906
Practice Address - Street 1:4400 NE 77TH AVE STE 275
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6857
Practice Address - Country:US
Practice Address - Phone:360-685-1597
Practice Address - Fax:360-249-9906
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60742923101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health