Provider Demographics
NPI:1437381837
Name:BLUMENTRITT, KATHLEEN ELAINE (LMFT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELAINE
Last Name:BLUMENTRITT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51720 VILLAGER PKWY
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8543
Mailing Address - Country:US
Mailing Address - Phone:574-210-8644
Mailing Address - Fax:
Practice Address - Street 1:51720 VILLAGER PKWY
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8543
Practice Address - Country:US
Practice Address - Phone:574-210-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001714A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist