| Blake Malloy, | |
|
13603 80th Cir N, Maple Grove, MN 55369-8961 | |
| (763) 274-3120 | |
| (763) 274-3121 |
| Full Name | Blake Malloy |
|---|---|
| Gender | Male |
| Speciality | Counselor - Mental Health |
| Location | 13603 80th Cir N, Maple Grove, Minnesota |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033636519 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Blake Malloy, 1900 Silver Lake Rd Nw Ste 110, New Brighton, MN 55112-1789 Ph: (651) 628-9566 | Blake Malloy, 13603 80th Cir N, Maple Grove, MN 55369-8961 Ph: (763) 274-3120 |
Sarah Nicole Olson Venning, LICSW Counselor Medicare: Accepting Medicare Assignments Practice Location: 14500 99th Ave N, Maple Grove, MN 55369 Phone: 651-600-0342 | |
Daniel Knudson, LADC Counselor Medicare: Not Enrolled in Medicare Practice Location: 13603 80th Cir N, Maple Grove, MN 55369 Phone: 763-274-3120 Fax: 763-274-3121 | |
Alysha Kvam, Counselor Medicare: Medicare Enrolled Practice Location: 12918 63rd Ave N, Maple Grove, MN 55369 Phone: 763-210-9966 | |
Barbara Wormington, Counselor Medicare: Not Enrolled in Medicare Practice Location: 10650 County Road 81 Ste N, Maple Grove, MN 55369 Phone: 417-529-3250 | |
Martha Sepulveda, Counselor Medicare: Not Enrolled in Medicare Practice Location: 13603 80th Cir N, Maple Grove, MN 55369 Phone: 763-284-3706 Fax: 763-274-3121 | |
Kimberly Fothergill, Counselor Medicare: Not Enrolled in Medicare Practice Location: 13603 80th Cir N, Maple Grove, MN 55369 Phone: 763-274-3120 Fax: 763-274-3121 |