MEDICARE: MARIE BLUNT LPC

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	04564	AL

General Provider Information

NPI Number	:	1780149823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE BLUNT LPC

Provider Business Mailing Address
First Line	:	3552 PELHAM PKWY # 1086
Second Line	:
City	:	PELHAM
State	:	AL
Zip	:	35124-2012
Country	:	US
Telephone Number	:	901-450-9155
Fax Number	:

Provider Business Practice Location Address
First Line	:	6584 POPLAR AVE FL 2
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38138-3687
Country	:	US
Telephone Number	:	901-450-9155
Fax Number	:

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

Provider Enumeration Date	:	02/03/2019
Last Update Date	:	01/15/2025

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