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General NPI Number Information
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NPI Number | 1811239866
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Entity Type | Organization
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Legal Business Name | CATHEY BLAU
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Dates
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Enumeration Date | 03/17/2013
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Last Update Date | 03/17/2013
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Provider Practice Location Address
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Address Line | 6528A HILLSIDE AVE
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92277-3228
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Country | US
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Telephone | 760-367-2117
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Fax | 760-367-2117
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Provider Business Mailing Address
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Address Line | 87079 AMBOY RD
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92277-8533
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Country | US
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Telephone | 760-367-2117
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Fax | 760-367-2117
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Authorized Official
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Title or Position | THERAPIST/OFFICE MANAGER
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Name | CATHEY G. BLAU
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Credential | L.C.S.W.
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Telephone | 760-367-2117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS6702
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License Number State | CA
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