Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY 3223 | FL |
N | 103T00000X | Psychologist | PY 3223 | FL |
N | 102L00000X | Psychologist | PY3223 | FL |
N | 103T00000X | Psychologist | PY3223 | FL |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY 3223 | FL |
Y | 103G00000X | Clinical Psychologist | PY 3223 | FL |
Y | 103TC0700X | Clinical Psychologist | PY 3223 | FL |
N | 103TC1900X | Counseling Psychologist | PY 3223 | FL |
NPI | 1063577229 |
---|---|
Provider Name | Wesley Peter Blitchington |
First Address | Longwood, FL 32779-4459 |
Second Address | Longwood, FL 32779-4459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
053110 | VALUE OPTIONS (01) | FL |
593016832 | TRICARE (01) | FL |
6126818 | UNITED BEHAVIORAL HEALTH (01) | FL |
63893 | CIGNA (01) | FL |
75237 | BCBS FL (01) | FL |
75237 | MEDICARE P10 (01) | FL |