Eylin Margarita Blake, AMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

120639 Issued in CA

Practice address

1421 Guerneville Rd
Santa Rosa, CA 95403-7220

Phone

(707) 576-7700

NPI assigned

Aug 26, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598400000000",
    "number": "1124631494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 GUERNEVILLE RD STE 218",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954037255",
            "telephone_number": "707-576-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 GUERNEVILLE RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954037220",
            "telephone_number": "707-576-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "EYLIN",
        "middle_name": "MARGARITA",
        "credential": "AMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-26",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "8203",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "120639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delbert Lee Blackburn
• Blackwell Homes
• Bradley Thomas Blackwell
• Benjamin William Blair, R1499800323
• Christine Linda Blake, RPT
• Katie Blake, LCSW
• Lizabeth Donava Blanchard, PT
• Aleli Blanco, RN, PHN
• Richard D. Bland, MD
• Gary A Blank, PH.D.

• Marriage & Family Therapist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.