1699036301 NPI number — MRS. BRENDA BLASINGAME RICHTER M.ED., LMHC, NCC

Table of content: MRS. BRENDA BLASINGAME RICHTER M.ED., LMHC, NCC (NPI 1699036301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699036301 NPI number — MRS. BRENDA BLASINGAME RICHTER M.ED., LMHC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHTER
Provider First Name:
BRENDA
Provider Middle Name:
BLASINGAME
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LMHC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLASINGAME
Provider Other First Name:
BRENDA
Provider Other Middle Name:
KAYE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699036301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 W MAIN ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
INVERNESS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34450-4811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-442-9220
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
INVERNESS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34450-4811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-442-9220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2012

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 , with the licence number:  MH7636 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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