Provider Demographics
NPI:1245604982
Name:BLUNT, MARY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:BLUNT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11999 KATY FWY
Mailing Address - Street 2:SUITE 530
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1611
Mailing Address - Country:US
Mailing Address - Phone:832-303-9419
Mailing Address - Fax:866-264-9471
Practice Address - Street 1:11999 KATY FWY
Practice Address - Street 2:SUITE 530
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1611
Practice Address - Country:US
Practice Address - Phone:832-303-9419
Practice Address - Fax:866-264-9471
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66417101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional