MEDICARE: MS. HEATHER BLANKENSHIP MFT

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	106H00000X	Marriage & Family Therapist	52247	CA

General Provider Information

NPI Number	:	1962554121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER BLANKENSHIP MFT

Provider Business Mailing Address
First Line	:	1600 WEEOT WAY
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-4734
Country	:	US
Telephone Number	:	707-825-5000
Fax Number	:	707-825-6747

Provider Business Practice Location Address
First Line	:	2298 NORRIS AVE STE A
Second Line	:
City	:	CRESCENT CITY
State	:	CA
Zip	:	95531-9344
Country	:	US
Telephone Number	:	707-464-2919
Fax Number	:	707-464-8218

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/01/2014

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