Provider Demographics
NPI:1326562901
Name:NUNNELEY, BLAKE RANDOLPH (LPC)
Entity Type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:RANDOLPH
Last Name:NUNNELEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 N HALL ST STE 530
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5105
Mailing Address - Country:US
Mailing Address - Phone:214-606-2484
Mailing Address - Fax:214-942-3304
Practice Address - Street 1:3626 N HALL ST STE 530
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5105
Practice Address - Country:US
Practice Address - Phone:214-606-2484
Practice Address - Fax:214-942-3304
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional