Healthcare Provider Details

I. General information

NPI: 1760536882
Provider Name (Legal Business Name): MS. MARIA ELAINE BLAHUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7923 E KIOWA AVE
MESA AZ
85209-5019
US

IV. Provider business mailing address

7923 E KIOWA AVE
MESA AZ
85209-5019
US

V. Phone/Fax

Practice location:
  • Phone: 602-796-6442
  • Fax:
Mailing address:
  • Phone: 602-796-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number24047
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: