MEDICARE: KAREN R BLANDEN L.M.H.C.

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	101YM0800X	Mental Health Counselor	MH 8143	FL

General Provider Information

NPI Number	:	1669650974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN R BLANDEN L.M.H.C.

Provider Business Mailing Address
First Line	:	5121 EHRLICH RD STE 104B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-2015
Country	:	US
Telephone Number	:	813-931-8113
Fax Number	:	813-920-5191

Provider Business Practice Location Address
First Line	:	5121 EHRLICH RD STE 104B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-2015
Country	:	US
Telephone Number	:	813-931-8113
Fax Number	:	813-920-5191

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

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	05/13/2009

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