Healthcare Provider Details

I. General information

NPI: 1649655358
Provider Name (Legal Business Name): RANIELLE LEA BLOHM PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAINELLE LEA SMITH PSYD

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 11/28/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 E ACCIPITER CIR
CLARKSVILLE TN
37043-2711
US

IV. Provider business mailing address

1004 HWY 104
IONE CA
95640
US

V. Phone/Fax

Practice location:
  • Phone: 949-421-9127
  • Fax:
Mailing address:
  • Phone: 209-274-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: