Provider Demographics
NPI:1558549220
Name:BLOOD, BARRY ELLSWORTH JR (LMHC)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:ELLSWORTH
Last Name:BLOOD
Suffix:JR
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9215 N FLORIDA AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7938
Mailing Address - Country:US
Mailing Address - Phone:813-930-7586
Mailing Address - Fax:866-499-0647
Practice Address - Street 1:9215 N FLORIDA AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7938
Practice Address - Country:US
Practice Address - Phone:813-930-7586
Practice Address - Fax:866-499-0647
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health