Heather Blackmore Ma Lmfta

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

License

MG60354376 Issued in WA

Legal business name

HEATHER BLACKMORE MA LMFTA

Practice address

374 NE Max William Loop
Poulsbo, WA 98370

Phone

(360) 649-1238

NPI assigned

Jul 15, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Heather Anne Blackmore, MA LMFTA

Title

Owner

Phone

(360) 649-1238

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405382400000",
    "number": "1306253067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "374 NE MAX WILLIAM LOOP",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983709169",
            "telephone_number": "360-649-1238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 NE MAX WILLIAM LOOP",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "98370",
            "telephone_number": "360-649-1238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEATHER BLACKMORE MA LMFTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-15",
        "last_updated": "2014-07-15",
        "status": "A",
        "authorized_official_last_name": "BLACKMORE",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-649-1238",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA LMFTA"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "WA",
            "license": "MG60354376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adolescent and Children Mental Health Clinic/Center in Poulsbo, WA
• Providers in Poulsbo, WA by specialty
• Adolescent and Children Mental Health Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.