Provider Demographics
NPI:1275967309
Name:FABIAN, KATY BLANKENSHIP (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:BLANKENSHIP
Last Name:FABIAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 CASCADE FALLS WAY
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-8248
Mailing Address - Country:US
Mailing Address - Phone:850-556-6855
Mailing Address - Fax:
Practice Address - Street 1:80 CASCADE FALLS WAY
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-8248
Practice Address - Country:US
Practice Address - Phone:850-556-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health