Provider Demographics
NPI:1194868190
Name:BLACH, SUE ANN (LMFT,ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:ANN
Last Name:BLACH
Suffix:
Gender:F
Credentials:LMFT,ATR-BC
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:ANN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:47825 OASIS ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-6950
Mailing Address - Country:US
Mailing Address - Phone:760-863-8455
Mailing Address - Fax:760-863-8587
Practice Address - Street 1:47825 OASIS ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-6950
Practice Address - Country:US
Practice Address - Phone:760-863-8455
Practice Address - Fax:760-863-8587
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 40423106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist