Provider Demographics
NPI:1649323361
Name:BLANTON, LYNN (LMFT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:BLANTON
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 1:6014 PALERMO WAY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5423
Mailing Address - Country:US
Mailing Address - Phone:916-933-1899
Mailing Address - Fax:
Practice Address - Street 1:993 GOVERNOR DR
Practice Address - Street 2:SUITE # 103
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4231
Practice Address - Country:US
Practice Address - Phone:916-933-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33575106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist