Individual
ALYSSA LOREN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
296 MERCHANTS SQ, DALLAS, GA 30132-5029
(470) 391-2300
Mailing address
7500 SAN FELIPE ST STE 990, HOUSTON, TX 77063-1708
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/14/2025
Last updated
07/14/2025
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