MEDICARE: BLANCHE HOWARD B.A., C.C.H.

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

General Provider Information

NPI Number	:	1598835381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLANCHE HOWARD B.A., C.C.H.

Provider Business Mailing Address
First Line	:	HC 88 BOX 424
Second Line	:
City	:	POCONO LAKE
State	:	PA
Zip	:	18347-9612
Country	:	US
Telephone Number	:	570-646-0335
Fax Number	:	570-646-7418

Provider Business Practice Location Address
First Line	:	HC 88 BOX 424
Second Line	:
City	:	POCONO LAKE
State	:	PA
Zip	:	18347-9612
Country	:	US
Telephone Number	:	570-646-0335
Fax Number	:	570-646-7418

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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