MEDICARE: MELISSA J BLOWER LPCC 13751

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	13751	CA

General Provider Information

NPI Number	:	1659059756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA J BLOWER LPCC 13751

Provider Business Mailing Address
First Line	:	6878 AVIENDA DE LOS FOOTHILLS
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-4270
Country	:	US
Telephone Number	:	949-233-2996
Fax Number	:

Provider Business Practice Location Address
First Line	:	6878 AVIENDA DE LOS FOOTHILLS
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-4270
Country	:	US
Telephone Number	:	949-233-2996
Fax Number	:

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

Provider Enumeration Date	:	07/07/2023
Last Update Date	:	07/07/2023

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