Blake Brisbois, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY32519 Issued in CA

Practice address

2625 Townsgate Rd Ste 210
Westlake VLG, CA 91361-5754

Phone

(805) 497-0605

Fax

(805) 371-4862

NPI assigned

Apr 14, 2016

Sex

Male

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

Locations

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.

• Engage Psychotherapy, Inc.

  • Community/Behavioral Health Agency
  • Westlake VLG, CA
  • NPI 1154998037
  NPD Authorized official
• Engage Treatment Program, Inc

  • Community/Behavioral Health Agency
  • Westlake Village, CA
  • NPI 1801436019
  NPD
• Calabasas TMS Center, Inc.

  • Psychiatry Physician
  • Calabasas, CA
  • NPI 1356768386
  NPD (past)
• Mindy Werner-Crohn, M.D., Inc,

  • Psychologist
  • Oakland, CA
  • NPI 1871844787

  Clinical

  NPD (past)

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

{
    "created_epoch": "1460592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1669826723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 TOWNSGATE RD STE 210",
            "city": "WESTLAKE VLG",
            "state": "CA",
            "postal_code": "913615754",
            "telephone_number": "805-497-0605",
            "fax_number": "805-371-4862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 TOWNSGATE RD STE 210",
            "city": "WESTLAKE VLG",
            "state": "CA",
            "postal_code": "913615754",
            "telephone_number": "805-497-0605",
            "fax_number": "805-371-4862"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "23622 Calabasas Rd",
            "address_2": "Suite 301",
            "address_purpose": "LOCATION",
            "city": "Calabasas",
            "state": "CA",
            "postal_code": "913021549",
            "country_code": "US",
            "telephone_number": "818-921-4300 x7",
            "fax_number": "877-917-3450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRISBOIS",
        "first_name": "BLAKE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-14",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "32519",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY32519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sedygheh M Banki, DDS
• Karen Begun, PSY.D.
• Lawrence Napoleon Borelli, MD
• Richard G Borquez, DDS
• Tiifany Renee Brannigan, MFT,MS
• William Cipriano, M.D.
• Darren F X Clair MD Inc a Professional Medical Corporation
• Engage Psychotherapy, Inc.
• Elizabeth P. Irias, LMFT
• Caitlin Mae Johnson

• Clinical Psychologist in Westlake VLG, CA
• Providers in Westlake VLG, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; 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.