Provider Demographics
NPI:1164115333
Name:MENDENHALL, BLUE MARIE
Entity type:Individual
Prefix:
First Name:BLUE
Middle Name:MARIE
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONIA
Other - Middle Name:MARIE
Other - Last Name:MENDENHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5203
Mailing Address - Country:US
Mailing Address - Phone:614-324-4800
Mailing Address - Fax:
Practice Address - Street 1:1876 N 4TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-1704
Practice Address - Country:US
Practice Address - Phone:614-324-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.185574101YA0400X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No172V00000XOther Service ProvidersCommunity Health Worker