Provider Demographics
NPI:1932274750
Name:BLAKE, BRENDA G (LPCC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:G
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 BETHESDA DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7500
Mailing Address - Country:US
Mailing Address - Phone:740-452-4539
Mailing Address - Fax:740-452-5702
Practice Address - Street 1:975 BETHESDA DR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-7500
Practice Address - Country:US
Practice Address - Phone:740-452-4539
Practice Address - Fax:740-452-5702
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0002604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health