=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093006454
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIFFANY BLASSINGAME LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2011
-----------------------------------------------------
Last Update Date | 04/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 737 LAMAR AVE
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75460-4479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-785-0400
-----------------------------------------------------
Fax | 903-785-0403
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 737 LAMAR AVENUE
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-785-0400
-----------------------------------------------------
Fax | 903-785-0403
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------