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General NPI Number Information
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NPI Number | 1942675350
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Entity Type | Organization
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Legal Business Name | BLASH COUNSELING ASSOCIATES
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 12/10/2015
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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 | 314-503-1746
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Fax |
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Provider Business Mailing 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 | 314-503-1746
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Fax |
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Authorized Official
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Title or Position | OFFICE COORDINATOR
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Name | MRS. TINA MAE BROOKS
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Credential |
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Telephone | 314-503-1746
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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 | 2015009900
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License Number State | MO
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