Provider Demographics
NPI:1528224433
Name:BLOUNT, ANTHONY HAROLD (BCBA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:HAROLD
Last Name:BLOUNT
Suffix:
Gender:M
Credentials:BCBA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 BENEDICTINE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-5860
Mailing Address - Country:US
Mailing Address - Phone:407-697-9247
Mailing Address - Fax:
Practice Address - Street 1:4213 BENEDICTINE CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-5860
Practice Address - Country:US
Practice Address - Phone:407-697-9247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1528389590Medicaid