Most Relevant Information
Provider Data
| NPI Number: | 1003288382 |
| Provider Name: | BLAKE EDMOND |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/26/2015 |
| Last Updated: | 10/26/2015 |
Provider Practice Location
1333 IRIS AVE
BOULDER
CO
803042226
Practice Location Phone/Fax
| Phone: | 3034438500 |
| Fax: |
Provider Mailing Location
1333 IRIS AVE
BOULDER
CO
803042226
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |