Provider Demographics
NPI:1881408557
Name:VAN OOSBREE, BLAKE MICHAEL (AAC)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:MICHAEL
Last Name:VAN OOSBREE
Suffix:
Gender:M
Credentials:AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 5TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2377
Mailing Address - Country:US
Mailing Address - Phone:206-263-9105
Mailing Address - Fax:
Practice Address - Street 1:401 5TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2377
Practice Address - Country:US
Practice Address - Phone:206-263-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61637364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health