Individual
TIMOTHY BLANKENBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
430 DIXIE PLZ, NATCHITOCHES, LA 71457-5881
(318) 357-9009
(318) 357-9008
Mailing address
1000 CHINABERRY DR STE 902, BOSSIER CITY, LA 71111-2455
(318) 459-6795
(318) 841-1210
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4642
LA
Other
Enumeration date
05/14/2013
Last updated
12/06/2019
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