Healthcare Provider Details

I. General information

NPI: 1851541833
Provider Name (Legal Business Name): MONICA T BLEDSOE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROFESSIONAL PARK DR
GLASGOW KY
42141-3487
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-9696
  • Fax: 270-651-0385
Mailing address:
  • Phone: 270-858-6655
  • Fax: 270-858-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0934
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number103017
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: