1891882064 NPI number — MR. MITCHELL B. BLOCKER LMHC, CAP, NCC

Table of content: MR. MITCHELL B. BLOCKER LMHC, CAP, NCC (NPI 1891882064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891882064 NPI number — MR. MITCHELL B. BLOCKER LMHC, CAP, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLOCKER
Provider First Name:
MITCHELL
Provider Middle Name:
B.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMHC, CAP, NCC
Provider Gender Code:
M

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:
1891882064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 53589
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT BENNING
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31995-3589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-545-8372
Provider Business Mailing Address Fax Number:
706-545-8364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7950 MARTIN LOOP BLDG 324
Provider Second Line Business Practice Location Address:
FT BENNING ASAP
Provider Business Practice Location Address City Name:
FT. BENNING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-545-8372
Provider Business Practice Location Address Fax Number:
706-545-8364
Provider Enumeration Date:
10/06/2006

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: 101YA0400X , with the licence number:  MH- 8628 , 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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