MEDICARE: MS. DANIELLE ANASTASHIA BLEA T-LMFT

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	106H00000X	Marriage & Family Therapist	992	KS

General Provider Information

NPI Number	:	1073769865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE ANASTASHIA BLEA T-LMFT

Provider Business Mailing Address
First Line	:	1805 S. OHIO ST.
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67402-2117
Country	:	US
Telephone Number	:	785-825-6224
Fax Number	:	785-827-7895

Provider Business Practice Location Address
First Line	:	651 E. PRESCOTT
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67402-2117
Country	:	US
Telephone Number	:	785-825-7251
Fax Number	:	785-825-6887

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	03/25/2014

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