Provider Demographics
NPI:1275317711
Name:BLOUNT, LAKEMIE CATRICIA
Entity Type:Individual
Prefix:
First Name:LAKEMIE
Middle Name:CATRICIA
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 TECHNOLOGY CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2191
Mailing Address - Country:US
Mailing Address - Phone:949-309-1378
Mailing Address - Fax:844-548-0616
Practice Address - Street 1:525 TECHNOLOGY CT
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2191
Practice Address - Country:US
Practice Address - Phone:949-309-1378
Practice Address - Fax:844-548-0616
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician