Blake Denver Altom, M.S., MFT INTERN

Primary specialty

Foster Care AgencyTaxonomy code 253J00000X

Practice address

242 Rosewood Cir
Logan, UT 84321-5045

Phone

(435) 512-1304

NPI assigned

Apr 15, 2010

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

• Mr. Blake Altom Other name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 15, 2010.

{
    "created_epoch": "1271289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271289600000",
    "number": "1255657201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 ROSEWOOD CIR",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215045",
            "telephone_number": "435-512-1304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 ROSEWOOD CIR",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215045",
            "telephone_number": "435-512-1304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALTOM",
        "first_name": "BLAKE",
        "middle_name": "DENVER",
        "name_prefix": "Mr.",
        "credential": "M.S., MFT INTERN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-15",
        "last_updated": "2010-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "UT",
            "license": "7195889-3904",
            "primary": false
        },
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BLAKE",
            "last_name": "ALTOM",
            "prefix": "MR.",
            "credential": "BLAKE ALTOM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• All providers in Logan, UT
• Foster Care Agency in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2010; 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.