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General NPI Number Information
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NPI Number | 1528861739
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Entity Type | Organization
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Legal Business Name | BLASE THERAPY SOLUTIONS
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 7831 E BUSH LAKE RD # 200
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City | MINNEAPOLIS
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State | MN
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Zip | 55439-3118
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Country | US
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Telephone | 847-477-9964
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Fax |
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Provider Business Mailing Address
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Address Line | 3640 43RD AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55406-2823
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Country | US
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Telephone | 847-477-9964
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | ELIJAH BLASE
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Credential | LICSW
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Telephone | 847-477-9964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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