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NPI Code Detail

MEDICARE: WILLIAM CAMPBELL BLAKE ED.D.

MEDICARE: WILLIAM CAMPBELL BLAKE ED.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorMH3561FL

General Provider Information

NPI Number : 1013162825
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM CAMPBELL BLAKE ED.D.
Provider Business Mailing Address
First Line : 605 S FREMONT AVE
Second Line : SUITE A
City : TAMPA
State : FL
Zip : 33606-2479
Country : US
Telephone Number : 813-417-8552
Fax Number : 813-258-0600
Provider Business Practice Location Address
First Line : 605 S FREMONT AVE
Second Line : SUITE A
City : TAMPA
State : FL
Zip : 33606-2479
Country : US
Telephone Number : 813-417-8552
Fax Number : 813-258-0600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2008
Last Update Date : 11/20/2008

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