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General NPI Number Information
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NPI Number | 1376447441
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Entity Type | Individual
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Provider Name | ISAIAH BLAKE
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Gender | Male
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 82 S BALTIC PL
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City | MERIDIAN
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State | ID
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Zip | 83642-5935
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Country | US
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Telephone | 208-740-0544
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Fax |
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Provider Business Mailing Address
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Address Line | 6692 S OROFINO CREEK PL
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City | MERIDIAN
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State | ID
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Zip | 83642-9454
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Country | US
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Telephone | 541-405-5687
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2771690
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License Number State | ID
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