Geoffrey Blake
Individual provider Active NPI Pastoral Counselor · Daphne, AL
NPI 1730710591 · NPPES record last updated Jan 30, 2020
Key facts
- NPI
- 1730710591
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pastoral Counselor 101YP1600X
- License
- 17802 (AL)
- Practice address
- 24682 Chantilly LN
Daphne, AL 36526-8730 - Phone
- (251) 591-4740
- NPI assigned
- Jan 30, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17802 | AL | MD | Pastoral Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | 17802 | AL | Yes |
Addresses
Primary practice location
24682 Chantilly LN
Daphne, AL 36526-8730
Mailing address
24682 Chantilly LN
Daphne, AL 36526-8730
Other providers in Daphne, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.