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Individual

BLAKE AUSTIN HARRELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
1100 WILFORD HALL LOOP, JBSA LACKLAND AFB, TX 78236-5638
(210) 292-7361
Mailing address
1100 WILFORD HALL LOOP, JBSA LACKLAND, TX 78236-5638
(102) 292-7361

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
0102206355
VA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
0102206355
VA

Other

Enumeration date
04/02/2019
Last updated
05/15/2025
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