Blake Andrew Shupe, AOD COUNSELOR

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

7581 Issued in CA

Practice address

201 Brush St
Ukiah, CA 95482-3424

Phone

(707) 462-6290

NPI assigned

Sep 11, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Ford Street Project

  • Substance Abuse Rehabilitation Facility
  • Ukiah, CA
  • NPI 1073946547
  NPD (past)

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

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536624000000",
    "number": "1609359090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2365 ROAD E",
            "city": "REDWOOD VALLEY",
            "state": "CA",
            "postal_code": "954709517",
            "telephone_number": "707-462-6290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 BRUSH ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954823424",
            "telephone_number": "707-462-6290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUPE",
        "first_name": "BLAKE",
        "middle_name": "ANDREW",
        "credential": "AOD COUNSELOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-11",
        "last_updated": "2018-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "7581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CADTP",
            "identifier": "7581",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kinderlynn Shields
• Gurpreet K Shires, APRN-CNP
• Deja Sholk
• Marli Docarmo Shoop, LCSW
• Genevieve Aileen Shouff
• Theresa Silsbee
• Kimberly Joe Silva, NP
• Melinda Silva
• Sherry Silva, RAS
• Fernando Silveira

• Addiction (Substance Use Disorder) Counselor in Ukiah, CA
• Providers in Ukiah, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; 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.