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Individual

BLAKE DAVIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
813 W 11TH ST STE B, AUSTIN, TX 78701-2058
(512) 554-4035
Mailing address
813 W 11TH ST STE B, AUSTIN, TX 78701-2058
(512) 554-4035

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
54097
TX

Other

Enumeration date
12/04/2015
Last updated
12/04/2015
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