Healthcare Provider Details

I. General information

NPI: 1588138077
Provider Name (Legal Business Name): LAURA BETH BLOMQUIST M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 W PALMETTO PARK RD STE 407
BOCA RATON FL
33433-3425
US

IV. Provider business mailing address

6127 FAIR OAKS BLVD
CARMICHAEL CA
95608-4818
US

V. Phone/Fax

Practice location:
  • Phone: 954-227-2700
  • Fax:
Mailing address:
  • Phone: 916-974-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT4349
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: