MEDICARE: KRISTIN BLANEY, INDIVIDUAL & FAMILY THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1902594773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTIN BLANEY, INDIVIDUAL & FAMILY THERAPY, INC.

Provider Business Mailing Address
First Line	:	302 N EL CAMINO REAL STE 216
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4778
Country	:	US
Telephone Number	:	949-633-6516
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 N EL CAMINO REAL STE 216
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4778
Country	:	US
Telephone Number	:	949-633-6516
Fax Number	:

Authorized Official
Title or Position	:	LMFT
Name	:	MRS. KRISTIN JOANNA BLANEY
Credential	:	MA
Telephone Number	:	949-633-6516

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	04/28/2023

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