Provider Demographics
NPI:1467634618
Name:BLANTON, SATTIE MOYER (MFT)
Entity Type:Individual
Prefix:MS
First Name:SATTIE
Middle Name:MOYER
Last Name:BLANTON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 9TH STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402
Mailing Address - Country:US
Mailing Address - Phone:805-528-6808
Mailing Address - Fax:
Practice Address - Street 1:2122 9TH STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402
Practice Address - Country:US
Practice Address - Phone:805-528-6808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPC23844106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist