MEDICARE: MRS. TATIANA ASHLEY BAZELAIS LMHC-D

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	101YM0800X	Mental Health Counselor	010734	NY

General Provider Information

NPI Number	:	1407397599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TATIANA ASHLEY BAZELAIS LMHC-D

Provider Business Mailing Address
First Line	:	16 WILKEN LN
Second Line	:
City	:	BRENTWOOD
State	:	NY
Zip	:	11717-7515
Country	:	US
Telephone Number	:	631-683-8072
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 LOCUST AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-2207
Country	:	US
Telephone Number	:	631-683-8072
Fax Number	:

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

Provider Enumeration Date	:	03/09/2017
Last Update Date	:	06/08/2026

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