Provider Demographics
NPI:1760812853
Name:BLAZINA, LORA (LPC, MHSP)
Entity Type:Individual
Prefix:MRS
First Name:LORA
Middle Name:
Last Name:BLAZINA
Suffix:
Gender:F
Credentials:LPC, MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 W END AVE
Mailing Address - Street 2:#240
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2612
Mailing Address - Country:US
Mailing Address - Phone:615-320-1155
Mailing Address - Fax:615-320-1177
Practice Address - Street 1:1720 W END AVE
Practice Address - Street 2:#240
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2612
Practice Address - Country:US
Practice Address - Phone:615-320-1155
Practice Address - Fax:615-320-1177
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3074101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional