1376927798 NPI number — CHRISANDRA YVETTE BLOW M.A. COUNSELING

Table of content: CHRISANDRA YVETTE BLOW M.A. COUNSELING (NPI 1376927798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376927798 NPI number — CHRISANDRA YVETTE BLOW M.A. COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLOW
Provider First Name:
CHRISANDRA
Provider Middle Name:
YVETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A. COUNSELING
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376927798
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 730
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33802-0730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-236-1540
Provider Business Mailing Address Fax Number:
321-594-6096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1975 S JOHN YOUNG PKWY STE 203A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34741-0603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-236-1540
Provider Business Practice Location Address Fax Number:
321-594-6096
Provider Enumeration Date:
07/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com