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General NPI Number Information
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NPI Number | 1831677319
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Entity Type | Individual
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Provider Name | TERESA LYNN MARSHALL-BLAND
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Gender | Female
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 08/06/2018
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Provider Practice Location Address
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Address Line | 1218 W OAK ST
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City | LOUISVILLE
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State | KY
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Zip | 40210-1533
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Country | US
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Telephone | 502-636-1572
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Fax |
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Provider Business Mailing Address
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Address Line | 214 BRECKENRIDGE LN
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City | LOUISVILLE
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State | KY
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Zip | 40207-3868
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Country | US
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Telephone | 812-987-2043
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Fax | 502-709-4264
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 103337
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License Number State | KY
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