Provider Demographics
NPI:1770121519
Name:BLAISDELL, CHRISTINA RACHEL (LMFT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RACHEL
Last Name:BLAISDELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:RACHEL
Other - Last Name:SLOMSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5540 N ACADEMY BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3696
Mailing Address - Country:US
Mailing Address - Phone:719-266-2591
Mailing Address - Fax:719-434-9636
Practice Address - Street 1:5540 N ACADEMY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3696
Practice Address - Country:US
Practice Address - Phone:719-266-2591
Practice Address - Fax:719-434-9636
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0002206106H00000X
175T00000X
COMFTC.0013976106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer Specialist