Healthcare Provider Details

I. General information

NPI: 1598673576
Provider Name (Legal Business Name): CLAIRE BLAKE CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE STE 8109
MEMPHIS TN
38103-2816
US

IV. Provider business mailing address

7915 CAPITAL PEAK CV APT 304
MEMPHIS TN
38125-1581
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-6971
  • Fax:
Mailing address:
  • Phone: 901-287-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number785
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: