Provider Demographics
NPI:1699036301
Name:RICHTER, BRENDA BLASINGAME (MED, LMHC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:BLASINGAME
Last Name:RICHTER
Suffix:
Gender:F
Credentials:MED, LMHC, NCC
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:KAYE
Other - Last Name:BLASINGAME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 W MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450-4811
Mailing Address - Country:US
Mailing Address - Phone:352-442-9220
Mailing Address - Fax:
Practice Address - Street 1:111 W MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-4811
Practice Address - Country:US
Practice Address - Phone:352-442-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7636101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health