Provider Demographics
NPI:1508589763
Name:BLEDSOE, MCKELL L (CMHC INTERN)
Entity Type:Individual
Prefix:
First Name:MCKELL
Middle Name:L
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:CMHC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 E 2450 S STE 5A
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6285
Mailing Address - Country:US
Mailing Address - Phone:435-227-5506
Mailing Address - Fax:
Practice Address - Street 1:1611 E 2450 S STE 5A
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6285
Practice Address - Country:US
Practice Address - Phone:435-227-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty