Active NPI
Kyle Blaylock, ACSW
- Counselor
- Eureka, CA
National Provider Identifier
1487133609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 100601
- Practice address
- 2259 Myrtle Ave
Eureka, CA 95501-3325 - Phone
- (707) 444-8293
- Fax
- (707) 444-8298
- NPI assigned
- Aug 8, 2018
- Last updated
- Nov 14, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 100601 | CA | Primary |
Addresses
Primary practice location
2259 Myrtle Ave
Eureka, CA 95501-3325
Mailing address
2259 Myrtle Ave
Eureka, CA 95501-3325
Phone (707) 444-8293
Other practice location 1
3960 Walnut Dr
Eureka, CA 95503
Phone (707) 268-8722
Other practice location 2
720 Wood St
Eureka, CA 95501-4413
Phone (530) 693-8040
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100601 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Covenant Counseling Center | Past | Accepting new patients | |
| Remi Vista Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba six rivers counseling
- Community/Behavioral Health Agency
- Eureka, CA
- NPI 1497923312
-
- Case Management Agency
- Eureka, CA
- NPI 1558314161
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668384000000",
"number": "1487133609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2259 MYRTLE AVE",
"city": "EUREKA",
"state": "CA",
"postal_code": "955013325",
"telephone_number": "707-444-8293",
"fax_number": "707-444-8298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2259 MYRTLE AVE",
"city": "EUREKA",
"state": "CA",
"postal_code": "955013325",
"telephone_number": "707-444-8293",
"fax_number": "707-444-8298"
}
],
"practiceLocations": [
{
"address_1": "3960 Walnut Dr",
"address_purpose": "LOCATION",
"city": "Eureka",
"state": "CA",
"postal_code": "95503",
"country_code": "US",
"telephone_number": "707-268-8722",
"fax_number": "707-268-0218",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "720 Wood St",
"address_purpose": "LOCATION",
"city": "Eureka",
"state": "CA",
"postal_code": "955014413",
"country_code": "US",
"telephone_number": "530-693-8040",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLAYLOCK",
"first_name": "KYLE",
"credential": "ACSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-08",
"last_updated": "2022-11-14",
"certification_date": "2022-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": "100601",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eureka, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.