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General NPI Number Information
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NPI Number | 1730734997
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Entity Type | Individual
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Provider Name | HEATHER L BLASINGAME LCDC
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Gender | Female
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Dates
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Enumeration Date | 08/05/2019
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | 101 E PARK BLVD STE OFFICE47
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City | PLANO
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State | TX
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Zip | 75074-5483
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Country | US
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Telephone | 214-282-0258
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Fax | 972-696-0899
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Provider Business Mailing Address
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Address Line | 1364 RIGSBEE DR APT B
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City | PLANO
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State | TX
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Zip | 75074-7071
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Country | US
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Telephone | 214-282-0258
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Fax | 972-696-0899
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 14968
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License Number State | TX
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