Provider Demographics
NPI:1891815692
Name:BLOOD, CATHY (RN)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:BLOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:UT
Mailing Address - Zip Code:84647-1331
Mailing Address - Country:US
Mailing Address - Phone:435-462-2416
Mailing Address - Fax:435-462-9350
Practice Address - Street 1:255 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2699
Practice Address - Country:US
Practice Address - Phone:435-896-8236
Practice Address - Fax:435-896-9584
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT165117-3102101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor