| Doctor Name: | MR. KEVIN RANDALL BLANKENSHIP |
| NPI Number: | 1902122815 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1024 4th St Suite B Taft, CA - 93268 |
| Business Phone Number: | 6617542524 |
| Business Fax Number: | 6617656189 |
| Mailing Address: | 1024 4th St, Suite B TAFT |
| State: | CA |
| Postal Code: | 93268 |
| Phone Number: | 6617542524 |
| Fax Number: | 6617656189 |
| NPI Enumeration Date: | 04/16/2010 |
| NPI Last Update Date: | 04/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |