Healthcare Provider Details

I. General information

NPI: 1659433233
Provider Name (Legal Business Name): BECKY BLATNICK BECKY BLATNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BECKY BLATNICK MA, L.M.F.,T

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 9TH ST
CRESCENT CITY CA
95531-3430
US

IV. Provider business mailing address

422 9TH ST
CRESCENT CITY CA
95531-3430
US

V. Phone/Fax

Practice location:
  • Phone: 707-464-8451
  • Fax: 707-458-3074
Mailing address:
  • Phone: 707-464-8451
  • Fax: 707-458-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC18052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: