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NPI Code Detail

MEDICARE: MS. SHONDA FOUBLASSE LMFT

MEDICARE: MS. SHONDA FOUBLASSE 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 Therapist303418KY
2106H00000XMarriage & Family Therapist2138TN

General Provider Information

NPI Number : 1457169070
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHONDA FOUBLASSE LMFT
Provider Business Mailing Address
First Line : 650 JOEL DR
Second Line :
City : FORT CAMPBELL
State : KY
Zip : 42223-8355
Country : US
Telephone Number : 270-798-8400
Fax Number :
Provider Business Practice Location Address
First Line : 650 JOEL DR
Second Line :
City : FORT CAMPBELL
State : KY
Zip : 42223-8355
Country : US
Telephone Number : 270-798-8400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2024
Last Update Date : 06/23/2026

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Directions to “ MS. SHONDA FOUBLASSE LMFT” Practice Location

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