Active NPI
Carl C Blake, LPC
- Mental Health Counselor
- Larkspur, CO
National Provider Identifier
1811018138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC 4701
- Practice address
- 12163 South Perry Park Road
Larkspur, CO 80118 - Phone
- (303) 681-2400
- Fax
- (303) 681-2401
- NPI assigned
- Apr 3, 2007
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC 4701 | CO | Primary |
Addresses
Primary practice location
12163 South Perry Park Road
Larkspur, CO 80118
Mailing address
14142 Denver West Pkwy
Suite 225
Lakewood, CO 80401-3189
Phone (303) 237-6865
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 78732069 | Medicaid | CO |
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 |
|---|---|---|---|
| LPC 4701 | CO | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1811018138",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14142 DENVER WEST PKWY",
"address_2": "SUITE 225",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "804013189",
"telephone_number": "303-237-6865",
"fax_number": "303-237-6873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12163 SOUTH PERRY PARK ROAD",
"city": "LARKSPUR",
"state": "CO",
"postal_code": "80118",
"telephone_number": "303-681-2400",
"fax_number": "303-681-2401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKE",
"first_name": "CARL",
"middle_name": "C",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-03",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CO",
"license": "LPC 4701",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "78732069",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Larkspur, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.