Provider Demographics
NPI:1962554121
Name:BLANKENSHIP, HEATHER (MFT)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 WEEOT WAY
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4734
Mailing Address - Country:US
Mailing Address - Phone:707-825-5000
Mailing Address - Fax:707-825-6747
Practice Address - Street 1:2298 NORRIS AVE STE A
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-9344
Practice Address - Country:US
Practice Address - Phone:707-464-2919
Practice Address - Fax:707-464-8218
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52247106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist