Individual
TAYLOR BLAKE EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDC
Contact information
Practice address
904 FM 686, DAYTON, TX 77535-2299
(936) 257-8584
Mailing address
3306 ABBEY FIELD LN, PORTER, TX 77365-8514
(903) 754-3457
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16715
TX
Other
Enumeration date
11/29/2023
Last updated
12/27/2023
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