Jennifer Lynn Blake, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

015211 Issued in NY

Practice address

98 N 2ND St
Fulton, NY 13069-1254

Phone

(315) 326-3555

NPI assigned

Apr 19, 2023

Last updated

Oct 1, 2024By the provider in NPPES

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stillwater Wellness

  • Mental Health Counselor
  • Binghamton, NY
  • NPI 1447130554
  NPD Authorized official

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

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1366139552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 N 2ND ST",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130691254",
            "telephone_number": "315-326-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 N 2ND ST",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130691254",
            "telephone_number": "315-326-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-19",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "18-P119545-01",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "015211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Lynn Benn
• Enearay Bennett
• Tyanna Bergeron, NP
• Beyond Words Healing Services LLC
• Kori L Birchenough, D.C.
• Diane Blasczienski
• Botty & Devito, D.D.S., L.L.P.
• Michael J. Botty, D.D.S.
• Paula M Bourgeois, LPN
• Deneen D Bowman, FNP

• Mental Health Counselor in Fulton, NY
• Providers in Fulton, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; 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.