Provider Demographics
NPI:1689027922
Name:THOMPSON, BLAKE (LMHC)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 3RD AVE STE 923
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1191
Mailing Address - Country:US
Mailing Address - Phone:206-503-3753
Mailing Address - Fax:
Practice Address - Street 1:1904 3RD AVE STE 923
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1191
Practice Address - Country:US
Practice Address - Phone:206-503-3753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60884873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60884873OtherWA STATE DEPARTMENT OF HEALTH LICENSE NUMBER