MEDICARE: DR. TRACY LYN BLANCHARD PSYCHOTHERAPIST

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	MH12550	FL

General Provider Information

NPI Number	:	1861808040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY LYN BLANCHARD PSYCHOTHERAPIST

Provider Business Mailing Address
First Line	:	13035 W LINEBAUGH AVE
Second Line	:	101
City	:	TAMPA
State	:	FL
Zip	:	33626-4481
Country	:	US
Telephone Number	:	813-992-9686
Fax Number	:

Provider Business Practice Location Address
First Line	:	13035 W LINEBAUGH AVE
Second Line	:	101
City	:	TAMPA
State	:	FL
Zip	:	33626-4481
Country	:	US
Telephone Number	:	813-992-9686
Fax Number	:

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

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	07/08/2014

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