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1033636519
BLAKE MALLOY
MAPLE GROVE, MN
NPI
1033636519
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2017-08-25
Last Update Date
2017-08-25
Business Address
BLAKE MALLOY
13603 80TH CIR N
MAPLE GROVE, MN 55369-8961
Phone number: 763-274-3120
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Mailing Address
BLAKE MALLOY
1900 SILVER LAKE RD NW STE 110
NEW BRIGHTON, MN 55112-1789
Phone number: 651-628-9566
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