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

Q: What is the provider's specialty?

The provider's specialty is Counselor with taxonomy code 101YM0800X and a focus in Mental Health.

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: July 19, 2026.

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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.