Provider Demographics
NPI:1003690595
Name:BLANCHARD, GERAL THOMAS (LPC)
Entity Type:Individual
Prefix:
First Name:GERAL
Middle Name:THOMAS
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-3043
Mailing Address - Country:US
Mailing Address - Phone:515-279-6900
Mailing Address - Fax:
Practice Address - Street 1:17 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3043
Practice Address - Country:US
Practice Address - Phone:515-279-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY494101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional