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NPI Code Detail

MEDICARE: MELISSA BLAKE

MEDICARE: MELISSA BLAKE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor17739MD

General Provider Information

NPI Number : 1235061334
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA BLAKE
Provider Business Mailing Address
First Line : 2709 CHIPPEWA CT
Second Line :
City : FINKSBURG
State : MD
Zip : 21048-1536
Country : US
Telephone Number : 443-789-2199
Fax Number :
Provider Business Practice Location Address
First Line : 55 WADE AVE
Second Line :
City : CATONSVILLE
State : MD
Zip : 21228-4663
Country : US
Telephone Number : 443-789-2199
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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Directions to “ MELISSA BLAKE ” Practice Location

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