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General NPI Number Information
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NPI Number | 1164394060
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Entity Type | Organization
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Legal Business Name | BLAKEMORE INSPIRED WELLNESS, MARRIAGE FAMILY THERAPY, PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 3200 E GUASTI RD STE 144
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City | ONTARIO
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State | CA
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Zip | 91761-8661
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Country | US
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Telephone | 714-519-6704
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 E GUASTI RD STE 144
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City | ONTARIO
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State | CA
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Zip | 91761-8661
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Country | US
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Telephone | 714-519-6704
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | SHARAYZA RACHAEL BLAKEMORE
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Credential | LMFT
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Telephone | 714-519-6704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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