Provider Demographics
NPI:1205395845
Name:KLEINFALL, BLANCA (MED)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:
Last Name:KLEINFALL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:
Other - Last Name:CARRILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 PRESTON RD APT 2107
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5131
Mailing Address - Country:US
Mailing Address - Phone:214-208-6168
Mailing Address - Fax:
Practice Address - Street 1:1500 PRESTON RD APT 2107
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5131
Practice Address - Country:US
Practice Address - Phone:214-208-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76907101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health