Healthcare Provider Details

I. General information

NPI: 1992218036
Provider Name (Legal Business Name): DR. BLAKE HARDING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2017
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 11TH AVE STE 400
SEATTLE WA
98122-4271
US

IV. Provider business mailing address

1424 11TH AVE STE 400
SEATTLE WA
98122-4271
US

V. Phone/Fax

Practice location:
  • Phone: 310-427-1520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSYC.00015400
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: