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BLAKE MALLOY
NPI 1033636519
Counselor - Mental Health in Maple Grove, MN

Active since August 25, 2017PECOS Enrolled
13603 80TH CIR N, MAPLE GROVE, MN 55369(763) 274-3120(763) 274-3121 Get Directions Write a Review

NPPES record last updated: August 25, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Blake Malloy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLAKE MALLOY (NPI 1033636519) is an individual mental health provider in Maple Grove, Minnesota and active in the NPI registry since August 2017. He is enrolled in Medicare PECOS and is a graduate of Other (2009).

NPPES Registry Identity

NPI1033636519
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameBLAKE MALLOY
Location Address13603 80TH CIR NMaple Grove, MN 55369-8961
Mailing Address1900 Silver Lake Rd Nw Ste 110New Brighton, MN 55112-1789 · (651) 628-9566 · Fax (651) 628-0411
Phone(763) 274-3120
Fax(763) 274-3121
Sole ProprietorNo
Medical School CMSOtherGraduated 2009
Enumeration DateAugust 25, 2017
✔ NPI 1033636519 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
13603 80TH CIR N, Maple Grove, MN 55369
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Blake Malloy is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1355830647
PECOS Enrollment IDI20251028001148
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DAVID M. KOSFELD LMFT
Marriage & Family Therapist
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 274-3120
DR. ANITA THAMPY M.D
Psychiatry & Neurology (Psychiatry)
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 274-3120
AMOS KOUKOU MSW, LGSW
Social Worker (Clinical)
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 274-3120
DANIEL KNUDSON LADC
Counselor (Addiction (Substance Use Disorder))
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 274-3120
DERELLE R MORRISON
Marriage & Family Therapist
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 274-3120
MARTHA SEPULVEDA
Counselor (Mental Health)
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 284-3706
DR. ROCHELLE ELIZABETH MCCOURTNEY GREDVIG PSYD
Psychologist (Counseling)
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 274-3120
KIMBERLY FOTHERGILL
Counselor (Addiction (Substance Use Disorder))
13603 80TH CIR N
MAPLE GROVE, MN 55369
Hennepin County (763) 274-3120

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blake Malloy's NPI number?

The NPI number for Blake Malloy is 1033636519. It was assigned to this individual provider in the NPPES registry on August 25, 2017.

Where is Blake Malloy located?

Blake Malloy practices at 13603 80th Cir N, Maple Grove, MN 55369. The listed phone number is (763) 274-3120.

What is Blake Malloy's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Blake Malloy enrolled in Medicare?

Yes. Blake Malloy is registered in the Medicare PECOS enrollment system.

What insurance does Blake Malloy accept?

Health plans from HealthPartners list Blake Malloy as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Blake Malloy was last updated on August 25, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.