Provider Demographics
NPI:1407416670
Name:T BLENDEN COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:T BLENDEN COUNSELING & CONSULTING
Other - Org Name:TANYA BLENDEN
Other - Org Type:Other Name
Authorized Official - Title/Position:FOUNDER , CEO, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:BLENDEN DEVRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, LCDC, NCC,
Authorized Official - Phone:254-289-7373
Mailing Address - Street 1:14001 WALDEN RD STE 700
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5205
Mailing Address - Country:US
Mailing Address - Phone:254-289-7373
Mailing Address - Fax:936-582-0145
Practice Address - Street 1:14001 WALDEN RD STE 700
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5205
Practice Address - Country:US
Practice Address - Phone:254-289-7373
Practice Address - Fax:936-582-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3268245-02Medicaid