Provider Demographics
NPI:1417407537
Name:BLAGG, DAISY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAISY
Middle Name:
Last Name:BLAGG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W WOODARD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-3136
Mailing Address - Country:US
Mailing Address - Phone:903-462-0032
Mailing Address - Fax:903-496-0713
Practice Address - Street 1:305 W WOODARD ST STE 201
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-3136
Practice Address - Country:US
Practice Address - Phone:903-462-0032
Practice Address - Fax:903-496-0713
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37419103TC2200X, 103TC0700X
TX32694103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool