Perry Mason Blankenship, LPC
Individual provider Active NPI Professional Counselor · Glen Fork, WV
NPI 1992362768 · NPPES record last updated Nov 16, 2022
Key facts
- NPI
- 1992362768
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 2202 (WV)
- Practice address
- 4687 Poplar Gap Rd.
Glen Fork, WV 25845 - Phone
- (304) 923-0449
- NPI assigned
- May 28, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2202 | WV | Yes |
Addresses
Primary practice location
4687 Poplar Gap Rd.
Glen Fork, WV 25845
Mailing address
6252 Dawes Dr
King George, VA 22485-7147
Phone (304) 923-0449
Other providers in Glen Fork, WV
All providers in Glen Fork, WV · Professional Counselor in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.