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General NPI Number Information
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NPI Number | 1609763341
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH PRACTITIONERS
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 651 1ST ST W STE G
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City | SONOMA
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State | CA
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Zip | 95476-7046
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Country | US
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Telephone | 415-968-6515
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Fax |
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Provider Business Mailing Address
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Address Line | 836 SOUTHAMPTON RD # B115
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City | BENICIA
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State | CA
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Zip | 94510-1961
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Country | US
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Telephone | 415-968-6515
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Fax |
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Authorized Official
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Title or Position | VP
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Name | REBECCA BLAKESLEY
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Credential | PMHNP
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Telephone | 415-968-6515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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