Healthcare Provider Details

I. General information

NPI: 1023168937
Provider Name (Legal Business Name): GERRY DALE BLASINGAME MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 BECHELLI LANE SUITE 201B
REDDING CA
96002
US

IV. Provider business mailing address

3161 BECHELLI LANE SUITE 201B
REDDING CA
96002
US

V. Phone/Fax

Practice location:
  • Phone: 530-222-9225
  • Fax: 530-222-9227
Mailing address:
  • Phone: 530-222-9225
  • Fax: 530-222-9227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 24816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: