Healthcare Provider Details

I. General information

NPI: 1548392632
Provider Name (Legal Business Name): KATRINA LASCHELLE BLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3147 N MILLBROOK AVE
FRESNO CA
93703-1425
US

IV. Provider business mailing address

3147 N MILLBROOK AVE
FRESNO CA
93703-1425
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-4309
  • Fax:
Mailing address:
  • Phone: 559-453-4309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: