Provider Demographics
NPI:1053499459
Name:BLOUNT, HUGH GORDON (PHD)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:GORDON
Last Name:BLOUNT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:PSYCHOLOGICAL
Other - Middle Name:RESOURCE
Other - Last Name:CENTERS
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2150 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7045
Mailing Address - Country:US
Mailing Address - Phone:760-322-5191
Mailing Address - Fax:760-778-6984
Practice Address - Street 1:2150 E TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE 10
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7045
Practice Address - Country:US
Practice Address - Phone:760-322-5191
Practice Address - Fax:760-778-6984
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8495103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPL0084950Medicare ID - Type Unspecified