Individual
MR. TERRY BLAKENEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 HARRIS SPRINGS ROAD, LAS VEGAS, NV 89124-7817
(702) 872-5382
Mailing address
3936 SAVOY CT, LAS VEGAS, NV 89115-0316
(702) 757-5801
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CADC-I 01197
NV
171M00000X
Case Manager/Care Coordinator
Primary
CADC-I 01197
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15456189
—
NV
Enumeration date
07/25/2011
Last updated
07/01/2013
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