MEDICARE: CRISTA ELIZABETH COFFING-BLAIN LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	ATR00-141	FL
2	101YM0800X	Mental Health Counselor	IMH11428	FL
3	221700000X	Art Therapist	00-141	NM
4	221700000X	Art Therapist	00-141	FL
5	101YM0800X	Mental Health Counselor	16915	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053723411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTA ELIZABETH COFFING-BLAIN LMHC

Provider Business Mailing Address
First Line	:	255 S ORANGE AVE SUITE 104 #1446
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801
Country	:	US
Telephone Number	:	904-720-7629
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 S ORANGE AVE SUITE 104 #1446
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801
Country	:	US
Telephone Number	:	904-720-7629
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2014
Last Update Date	:	09/20/2024

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Directions to “ CRISTA ELIZABETH COFFING-BLAIN LMHC” Practice Location

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