MEDICARE: MS. BLYTHE ANNE HAMBURG P-LPC

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	P-1098	MS
2	101YP2500X	Professional Counselor	P-1098	MS
3	101YM0800X	Mental Health Counselor	P-1098	MS

General Provider Information

NPI Number	:	1093540148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BLYTHE ANNE HAMBURG P-LPC

Provider Business Mailing Address
First Line	:	130 KEY RD
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-9546
Country	:	US
Telephone Number	:	662-881-0281
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 BAILEY DR
Second Line	:
City	:	HOLLANDALE
State	:	MS
Zip	:	38748-3206
Country	:	US
Telephone Number	:	662-881-0281
Fax Number	:

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

Provider Enumeration Date	:	09/06/2024
Last Update Date	:	09/08/2024

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