Healthcare Provider Details

I. General information

NPI: 1881172856
Provider Name (Legal Business Name): BLAKE HUELSMAN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 09/11/2025
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 EZZARD CHARLES DR
CINCINNATI OH
45214-2525
US

IV. Provider business mailing address

1175 MARKLEY RD
CINCINNATI OH
45230-4130
US

V. Phone/Fax

Practice location:
  • Phone: 513-381-6672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1801252
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: