Provider Demographics
NPI:1639814916
Name:BLANDFORD, MONICA (LMFT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:BLANDFORD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 CAYUCOS AVE
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-2707
Mailing Address - Country:US
Mailing Address - Phone:805-952-3223
Mailing Address - Fax:
Practice Address - Street 1:4555 EL CAMINO REAL STE J
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-2700
Practice Address - Country:US
Practice Address - Phone:805-952-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146445106H00000X
CA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist