Provider Demographics
NPI:1407283641
Name:BLAS, FLORENCE SGRO (BS, IMFT)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:SGRO
Last Name:BLAS
Suffix:
Gender:F
Credentials:BS, IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 CHALAN SAN ANTONIO RD
Mailing Address - Street 2:PMB 103
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-929-7125
Mailing Address - Fax:
Practice Address - Street 1:213 CHALAN SANTO PAPA
Practice Address - Street 2:
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-989-7125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUIMF-36106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist