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1265969075
TAYLOR L BLAKE
SAN ANTONIO, TX
NPI
1265969075
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: TX 12305)
Enumeration Date
2017-05-11
Last Update Date
2017-05-11
Business Address
-- TAYLOR L BLAKE M.Ed, LCDC
6800 PARK TEN BLVD STE 200S
SAN ANTONIO, TX 78213-4293
Phone number: 210-261-1000
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Mailing Address
-- TAYLOR L BLAKE M.Ed, LCDC
6800 PARK TEN BLVD STE 200S ATTN: CREDENTIALING
SAN ANTONIO, TX 78213-4293
Phone number: 210-261-1000
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