Provider Demographics
NPI:1326348558
Name:BLOKSBERG, RACHELLE (LMFT)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:BLOKSBERG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 SUTTON WAY # 377
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5390
Mailing Address - Country:US
Mailing Address - Phone:530-263-1413
Mailing Address - Fax:
Practice Address - Street 1:142 EAST MCKNIGHT WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949
Practice Address - Country:US
Practice Address - Phone:530-263-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4624101YP2500X
CA119841106H00000X
246ZE0500X, 2472E0500X
CA101408106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG