Healthcare Provider Details

I. General information

NPI: 1174049035
Provider Name (Legal Business Name): BLAINE RIMER LMFT, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1196 THIRD AVE
CHULA VISTA CA
91911
US

IV. Provider business mailing address

1196 THIRD AVE
CHULA VISTA CA
91911-3131
US

V. Phone/Fax

Practice location:
  • Phone: 619-427-4661
  • Fax:
Mailing address:
  • Phone: 619-427-4661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10904
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5890
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number128805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: