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General NPI Number Information
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NPI Number | 1639516354
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Entity Type | Organization
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Legal Business Name | DANIEL L. BLASH, LLC
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 1323 SULLIVAN AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63107-3919
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Country | US
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Telephone | 417-860-2984
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Fax |
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Provider Business Mailing Address
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Address Line | 1454 WOODPATH DR
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City | FLORISSANT
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State | MO
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Zip | 63031-1163
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Country | US
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Telephone | 417-860-2984
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. DANIEL L BLASH
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Credential | PHD, LPC, NCC, ACS
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Telephone | 314-265-7014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2006005129
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License Number State | MO
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