MEDICARE: BLUE MARIE MENDENHALL

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.185574	OH
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1164115333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLUE MARIE MENDENHALL

Provider Business Mailing Address
First Line	:	211 S 5TH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-5203
Country	:	US
Telephone Number	:	614-324-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1876 N 4TH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-1704
Country	:	US
Telephone Number	:	614-324-4088
Fax Number	:

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

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	09/26/2025

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Directions to “ BLUE MARIE MENDENHALL ” Practice Location

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