Blake Evan Gilbo, M.S., LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2015041412 Issued in MO

Practice address

908 Crescent Dr Apt 1-1
Champaign, IL 61821-4270

Phone

(217) 974-9091

Fax

(217) 974-9091

NPI assigned

Jun 6, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Blossom Evonne Gilbo Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1338940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1497016380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 W MARVIN AVE",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451648",
            "telephone_number": "573-783-9248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 CRESCENT DR APT 1-1",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618214270",
            "telephone_number": "217-974-9091",
            "fax_number": "217-974-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILBO",
        "first_name": "BLAKE",
        "middle_name": "EVAN",
        "credential": "M.S., LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-06",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "2015041412",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "178.032745",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BLOSSOM",
            "last_name": "GILBO",
            "middle_name": "EVONNE",
            "credential": "LPC, NCC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Susan H Gibson, PT
• Kenneth Gordon Gilbert Jr., MD
• Laurie A. Gilbert, LCSW
• Stephanie Gilbert
• Thomas Gilbert, M.A.R.
• Tempestt Gill
• Joshua Brian Gille, DMD
• Naomi Gillett
• Pushpa Balgiri Giri, M.D.
• Laura Mary Girouard, M.S., CCC-SLP

• Mental Health Counselor in Champaign, IL
• Providers in Champaign, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; 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.