Provider Demographics
NPI:1417201500
Name:BLANCO, GERARDO (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:BLANCO
Suffix:
Gender:M
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 LEMMON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2145
Mailing Address - Country:US
Mailing Address - Phone:214-526-4525
Mailing Address - Fax:214-520-6468
Practice Address - Street 1:9477 FT WORTH DR
Practice Address - Street 2:RANCH HAND RESCUE
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76226-9371
Practice Address - Country:US
Practice Address - Phone:940-240-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68742106H00000X
TX201808106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist