Provider Demographics
NPI:1801820378
Name:BLEDSOE, JOHN L (D MIN, PH D, LPC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:BLEDSOE
Suffix:
Gender:M
Credentials:D MIN, PH D, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SHERWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701
Mailing Address - Country:US
Mailing Address - Phone:706-602-0339
Mailing Address - Fax:706-602-9359
Practice Address - Street 1:654 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1963
Practice Address - Country:US
Practice Address - Phone:706-602-0339
Practice Address - Fax:706-602-9359
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 1937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC 1937OtherCOUNSELING LICENSE