MEDICARE: MARIA DUNBLAZIER MS, NCC, LPCC, LADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	306205	MN
2	101YM0800X	Mental Health Counselor	3129	MN

General Provider Information

NPI Number	:	1568122992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA DUNBLAZIER MS, NCC, LPCC, LADC

Provider Business Mailing Address
First Line	:	3718 NE 48TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-3518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3718 NE 48TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-3518
Country	:	US
Telephone Number	:	507-690-2785
Fax Number	:

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

Provider Enumeration Date	:	12/27/2021
Last Update Date	:	10/31/2023

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