Provider Demographics
NPI:1518568120
Name:BLAKE, ADRIANA LYNN
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:LYNN
Last Name:BLAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 NE EDGECLIFF CIR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4159
Mailing Address - Country:US
Mailing Address - Phone:541-728-0465
Mailing Address - Fax:
Practice Address - Street 1:1646 NE EDGECLIFF CIR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4159
Practice Address - Country:US
Practice Address - Phone:541-728-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health