MEDICARE: CONSUELO NEGRETE BLAS LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LMFT163843	CA

General Provider Information

NPI Number	:	1043808207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSUELO NEGRETE BLAS LMFT

Provider Business Mailing Address
First Line	:	2070 N BROADWAY UNIT 4442
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94596-2018
Country	:	US
Telephone Number	:	925-759-0560
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 ARNOLD DR STE 170
Second Line	:
City	:	MARTINEZ
State	:	CA
Zip	:	94553-6537
Country	:	US
Telephone Number	:	925-372-4213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	06/09/2026

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