Provider Demographics
NPI:1558890368
Name:BLOUNT, STEVEN GREGORY III (CATC-REGISTERED)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:GREGORY
Last Name:BLOUNT
Suffix:III
Gender:M
Credentials:CATC-REGISTERED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:942 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4004
Mailing Address - Country:US
Mailing Address - Phone:323-410-1216
Mailing Address - Fax:323-263-8042
Practice Address - Street 1:942 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4004
Practice Address - Country:US
Practice Address - Phone:323-410-1216
Practice Address - Fax:323-263-8042
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111163-R101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)