Provider Demographics
NPI:1730079401
Name:BLAKE, TYRONE D II
Entity type:Individual
Prefix:
First Name:TYRONE
Middle Name:D
Last Name:BLAKE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 MOKELUMNE DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8089
Mailing Address - Country:US
Mailing Address - Phone:925-493-1561
Mailing Address - Fax:
Practice Address - Street 1:1297 MOKELUMNE DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8089
Practice Address - Country:US
Practice Address - Phone:925-493-1561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-05
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst