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NPI Code Detail

MEDICARE: DANIEL L. BLASH, LLC

MEDICARE: DANIEL L. BLASH, LLC
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
1101Y00000XCounselor2006005129MO

General Provider Information

NPI Number : 1639516354
Entity Type Code : Organization
Provider Name (Legal Business Name) : DANIEL L. BLASH, LLC
Provider Business Mailing Address
First Line : 1454 WOODPATH DR
Second Line :
City : FLORISSANT
State : MO
Zip : 63031-1163
Country : US
Telephone Number : 417-860-2984
Fax Number :
Provider Business Practice Location Address
First Line : 1323 SULLIVAN AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63107-3919
Country : US
Telephone Number : 417-860-2984
Fax Number :
Authorized Official
Title or Position : SOLE MEMBER
Name : DR. DANIEL L BLASH
Credential : PHD, LPC, NCC, ACS
Telephone Number : 314-265-7014
Provider Enumeration Date : 06/04/2013
Last Update Date : 06/04/2013

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Directions to “DANIEL L. BLASH, LLC ” Practice Location

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