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493 Main St Ste 210-b Diamond Springs CA 95619-9173 | |
| (530) 391-5990 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 493 Main St Ste 210-b, Diamond Springs, California |
| Authorized Official Name and Position | Kristie Blasingame (CEO/ OWNER/ LMFT) |
| Authorized Official Contact | 5308302727 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2786 Cambridge Rd Cameron Park CA 95682-9255 Ph: (530) 830-2727 | 493 Main St Ste 210-b Diamond Springs CA 95619-9173 Ph: (530) 391-5990 |
| NPI Number | 1457124109 |
|---|---|
| Provider Enumeration Date | 11/03/2023 |
| Last Update Date | 11/06/2023 |
| Certification Date | 11/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457124109 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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