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NPI Code Detail

MEDICARE: MRS. MIEKA K BLEDSOE MS, LMFT

MEDICARE: MRS. MIEKA K BLEDSOE MS, 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
1106H00000XMarriage & Family Therapist93391CA

General Provider Information

NPI Number : 1427671411
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MIEKA K BLEDSOE MS, LMFT
Provider Business Mailing Address
First Line : 5500 E ATHERTON ST STE 227B
Second Line :
City : LONG BEACH
State : CA
Zip : 90815-4018
Country : US
Telephone Number : 657-214-0087
Fax Number :
Provider Business Practice Location Address
First Line : 5500 E ATHERTON ST STE 227B
Second Line :
City : LONG BEACH
State : CA
Zip : 90815-4018
Country : US
Telephone Number : 657-214-0087
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2020
Last Update Date : 12/28/2020

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