| Doctor Name: | DR. ROBERT PHILP BLAKE |
| NPI Number: | 1174978191 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC #C3517 |
| License Number: | LPC #C3517 |
| Business Practice Address: | 603 Hemlock St Suite 2b Brookings, OR - 97415 |
| Business Phone Number: | 7072181758 |
| Business Fax Number: | |
| Mailing Address: | P O Box 175, FORT DICK |
| State: | CA |
| Postal Code: | 95538 |
| Phone Number: | 7072181758 |
| Fax Number: | |
| NPI Enumeration Date: | 04/27/2016 |
| NPI Last Update Date: | 04/27/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC #C3517 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |