Individual
TAYLOR L BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.ED, LCDC
Contact information
Practice address
6800 PARK TEN BLVD STE 200S, SAN ANTONIO, TX 78213-4293
(210) 261-1000
(210) 261-1821
Mailing address
6800 PARK TEN BLVD STE 200S, ATTN: CREDENTIALING, SAN ANTONIO, TX 78213-4293
(210) 261-1000
(210) 261-1821
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12305
TX
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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