Courtney Nicole Blassingame, LMSW
Individual provider Active NPI Social Worker · Tatum, TX
NPI 1194422642 · NPPES record last updated Feb 14, 2023
Key facts
- NPI
- 1194422642
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 104375 (TX)
- Practice address
- 1305 Lark St Apt 13
Tatum, TX 75691-1757 - Phone
- (903) 646-7069
- NPI assigned
- Feb 14, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104375 | TX | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 104375 | TX | Yes |
Addresses
Primary practice location
1305 Lark St Apt 13
Tatum, TX 75691-1757
Mailing address
1305 Lark St Apt 13
Tatum, TX 75691-1757
Phone (903) 646-7069
Other providers in Tatum, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.