Healthcare Provider Details

I. General information

NPI: 1356525679
Provider Name (Legal Business Name): TODD BLANCETT CADC-II, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 N 1ST ST SUITE 135
FRESNO CA
93726-6800
US

IV. Provider business mailing address

3636 N 1ST ST SUITE 135
FRESNO CA
93726-6800
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-1464
  • Fax: 559-225-1693
Mailing address:
  • Phone: 559-225-1464
  • Fax: 559-225-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number251S00000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: