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General NPI Number Information
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NPI Number | 1356204069
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Entity Type | Organization
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Legal Business Name | BLOWFISH THERAPY INC
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 100 W FOOTHILL BLVD STE 104
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City | SAN DIMAS
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State | CA
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Zip | 91773-1170
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Country | US
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Telephone | 909-660-9548
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Fax |
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Provider Business Mailing Address
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Address Line | 968 CARSON ST
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City | UPLAND
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State | CA
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Zip | 91784-1831
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Country | US
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Telephone | 909-660-9548
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHELSEA HELLER MCGRAY
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Credential | LMFT, LEP, ABSNP
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Telephone | 909-660-9548
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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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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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