Provider Demographics
NPI:1952620692
Name:BLACKWELL-SCHRAG, DEBRA GAIL (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:GAIL
Last Name:BLACKWELL-SCHRAG
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 W CHANNEL ISLANDS BLVD UNIT 591
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-2133
Mailing Address - Country:US
Mailing Address - Phone:805-252-1434
Mailing Address - Fax:
Practice Address - Street 1:119 FIGUEROA ST STE 5
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2756
Practice Address - Country:US
Practice Address - Phone:805-252-1434
Practice Address - Fax:805-856-2223
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61073134106H00000X
CA50499106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist