Provider Demographics
NPI:1639739121
Name:SILVER FIDDLE THERAPY
Entity Type:Organization
Organization Name:SILVER FIDDLE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-304-8821
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:CA
Mailing Address - Zip Code:95689-0182
Mailing Address - Country:US
Mailing Address - Phone:209-304-8821
Mailing Address - Fax:
Practice Address - Street 1:19881 STATE HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:PINE GROVE
Practice Address - State:CA
Practice Address - Zip Code:95665-9495
Practice Address - Country:US
Practice Address - Phone:209-560-6012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty