Provider Demographics
NPI:1275759086
Name:BLESIUS, RITA FAE (PHD PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:FAE
Last Name:BLESIUS
Suffix:
Gender:F
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SILENT CREST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-532-6463
Mailing Address - Fax:915-532-6463
Practice Address - Street 1:2100 EAST YANDELL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903
Practice Address - Country:US
Practice Address - Phone:915-545-4800
Practice Address - Fax:915-545-4802
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224033103TC1900X
TX106H00000X
TX24083163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
0002BTOtherTRICARE
0002BTMedicare ID - Type Unspecified
0002BTOtherTRICARE