Provider Demographics
NPI:1902087778
Name:OKORO RELLIAS, BLESSING A (PHD)
Entity Type:Individual
Prefix:DR
First Name:BLESSING
Middle Name:A
Last Name:OKORO RELLIAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12730 HEACOCK ST
Mailing Address - Street 2:SUITE #7
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3070
Mailing Address - Country:US
Mailing Address - Phone:951-221-3460
Mailing Address - Fax:951-924-0250
Practice Address - Street 1:12730 HEACOCK ST
Practice Address - Street 2:SUITE #7
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3070
Practice Address - Country:US
Practice Address - Phone:951-221-3460
Practice Address - Fax:951-924-0250
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47068106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health