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General NPI Number Information
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NPI Number | 1003408808
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Entity Type | Individual
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Provider Name | BRENDA BLAKE-JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 8410 W THOMAS RD STE 116
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City | PHOENIX
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State | AZ
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Zip | 85037-3356
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Country | US
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Telephone | 602-258-6797
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Fax |
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Provider Business Mailing Address
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Address Line | 3877 N 7TH ST STE 400
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City | PHOENIX
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State | AZ
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Zip | 85014-5061
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Country | US
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Telephone | 602-258-6797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 23246
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License Number State | AZ
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