Provider Demographics
NPI:1700601697
Name:BLYTHE LLC
Entity type:Organization
Organization Name:BLYTHE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT/SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:BLYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-264-9289
Mailing Address - Street 1:6708 VISTA LUCES ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-7067
Mailing Address - Country:US
Mailing Address - Phone:505-264-9289
Mailing Address - Fax:
Practice Address - Street 1:6708 VISTA LUCES ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-7067
Practice Address - Country:US
Practice Address - Phone:505-264-9289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty