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Active NPI 1699176677 Individual Practitioner

Captain Blake Soderstrom

Counselor - Mental Health • Brimley, MI

Professional Overview & Biography Verified Profile Summary

Captain Soderstrom is a registered healthcare professional specializing in Counselor - Mental Health in Brimley, MI. Practice services are available at PO BOX 303 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

Po Box 303

Brimley, MI 497150303

Telephone 9062038354

Specialty Benchmarks & Practice Insights

Comparative analytics for Counselor - Mental Health in Brimley, MI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 14.0 Yrs
Regional Practice Density
2 Specialists

Practicing in Brimley, MI (4123 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2024-04-05
Counselor - Mental Health Primary Specialty

NUCC Taxonomy Code: 101YM0800X

State License NY 010908-01

Definition to come...

Counselor - Mental Health

NUCC Taxonomy Code: 101YM0800X

State License MI 6401222931

Definition to come...

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
03505424 (NY)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

10 Historical Events
📍
Updated Practice Location April 05, 2024

Registered at PO BOX 303, BRIMLEY, MI 497150303 (Tel: 9062038354)

📍
Updated Business Mailing Address April 05, 2024

Registered at PO BOX 303, BRIMLEY, MI 497150303 (Tel: 9062038354)

👤
Provider Name / Credentials Updated April 05, 2024

Recorded as CAPTAIN SODERSTROM

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 05, 2024

Counselor (License #6401222931 in MI)

✅
NPI Profile Active March 30, 2016

NPI status registered as active in NPPES database

📍
Updated Practice Location March 30, 2016

Registered at 1841 BROADWAY, 4TH FLOOR, NEW YORK, NY 100237603 (Tel: 3479215052)

📍
Updated Business Mailing Address March 30, 2016

Registered at 1841 BROADWAY, 4TH FLOOR, NEW YORK, NY 100237603 (Tel: 3479215052)

👤
Provider Name / Credentials Updated March 30, 2016

Recorded as BLAKE SODERSTROM

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 30, 2016

Counselor

🟢
Initial NPI Registration & Enumeration September 10, 2014

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1699176677
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 10, 2014
Last Update: April 05, 2024
Sole Proprietor: Yes
Update or Correct Profile

Mailing Address

Po Box 303

Brimley, MI 497150303

Phone: 9062038354

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.