MEDICARE: BLYTHE 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
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1700601697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLYTHE LLC

Provider Business Mailing Address
First Line	:	6708 VISTA LUCES ST NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-7067
Country	:	US
Telephone Number	:	505-264-9289
Fax Number	:

Provider Business Practice Location Address
First Line	:	6708 VISTA LUCES ST NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-7067
Country	:	US
Telephone Number	:	505-264-9289
Fax Number	:

Authorized Official
Title or Position	:	AGENT/SOLE MEMBER
Name	:	MR. WILLIAM K BLYTHE
Credential	:	LPCC
Telephone Number	:	505-264-9289

Provider Enumeration Date	:	11/18/2024
Last Update Date	:	11/18/2024

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Directions to “BLYTHE LLC ” Practice Location

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