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KYLE ANDREW BLAKE LCSW

Clinical >> Social Worker >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1720559107

Individual Registrant:
 KYLE ANDREW BLAKE LCSW
Gender: M
Sole Proprietor

Location and contact information for practice:
10918 HESPERIA RD  HESPERIA, CA 92345-2151 US
Tel: 760-490-6484  Fax: --

Contact information for business:
PO BOX 2486  HELENDALE, CA 92342-2486 US
Tel: 760-490-6484  Fax: --

Registration Information:
NPI: 1720559107
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker
Clinical
CALCSW76408

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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