Provider Demographics
NPI:1497016380
Name:GILBO, BLAKE EVAN (MS, LPC)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:EVAN
Last Name:GILBO
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:BLOSSOM
Other - Middle Name:EVONNE
Other - Last Name:GILBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:206 W MARVIN AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-1648
Mailing Address - Country:US
Mailing Address - Phone:573-783-9248
Mailing Address - Fax:
Practice Address - Street 1:908 CRESCENT DR APT 1-1
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-4270
Practice Address - Country:US
Practice Address - Phone:217-974-9091
Practice Address - Fax:217-974-9091
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health