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General NPI Number Information
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NPI Number | 1245829803
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Entity Type | Individual
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Provider Name | JESSICA MARIE BLADES LMHC
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Gender | Female
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Dates
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Enumeration Date | 01/18/2021
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 10239 FALCON PARC BLVD APT 105
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City | ORLANDO
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State | FL
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Zip | 32832-5525
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Country | US
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Telephone | 561-635-9037
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Fax |
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Provider Business Mailing Address
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Address Line | 253 TALISI LOOP
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City | SAINT CLOUD
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State | FL
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Zip | 34771-9159
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Country | US
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Telephone | 561-635-9037
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH22422
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License Number State | FL
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