Provider Demographics
NPI:1588138077
Name:BLOMQUIST, LAURA BETH (MA)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:BETH
Last Name:BLOMQUIST
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6127 FAIR OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4818
Mailing Address - Country:US
Mailing Address - Phone:916-974-8090
Mailing Address - Fax:
Practice Address - Street 1:7000 W PALMETTO PARK RD STE 407
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3425
Practice Address - Country:US
Practice Address - Phone:954-227-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLMT4349106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor