Individual
DR. DERRICK K BLANTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PYSD
Contact information
Practice address
13284 BUGATTI DR, FRISCO, TX 75034-0916
(214) 551-7104
(214) 615-6358
Mailing address
13284 BUGATTI DR, FRISCO, TX 75034-0916
(214) 551-7104
(214) 615-6358
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
32512
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170206001
—
TX
Enumeration date
08/20/2006
Last updated
02/22/2010
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