Provider Demographics
NPI:1003694266
Name:BLACKMORE, HANNAH ELIZABETH (APCC)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:ELIZABETH
Last Name:BLACKMORE
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92822-0163
Mailing Address - Country:US
Mailing Address - Phone:562-360-4642
Mailing Address - Fax:
Practice Address - Street 1:3020 OLD RANCH PKWY
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2765
Practice Address - Country:US
Practice Address - Phone:562-568-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC14178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health