Provider Demographics
NPI:1730734997
Name:BLASINGAME, HEATHER L (LCDC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:BLASINGAME
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 RIGSBEE DR APT B
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-7071
Mailing Address - Country:US
Mailing Address - Phone:214-282-0258
Mailing Address - Fax:972-696-0899
Practice Address - Street 1:101 E PARK BLVD STE OFFICE47
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5483
Practice Address - Country:US
Practice Address - Phone:214-282-0258
Practice Address - Fax:972-696-0899
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14968101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)