MEDICARE: CARMINA BLASKO MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC.0012348	CO

General Provider Information

NPI Number	:	1356601637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMINA BLASKO MA, LPC

Provider Business Mailing Address
First Line	:	10537 KELOWNA VW
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-4520
Country	:	US
Telephone Number	:	719-650-3921
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 3RD ST STE 400
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-8179
Country	:	US
Telephone Number	:	719-259-4951
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2012
Last Update Date	:	02/20/2024

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