Provider Demographics
NPI:1497735716
Name:BLACKWELL-GARNER, MARY CATHERINE (MSN, CNS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARY CATHERINE
Middle Name:
Last Name:BLACKWELL-GARNER
Suffix:
Gender:F
Credentials:MSN, CNS, LMFT
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Mailing Address - Street 1:101 FEU FOLLET RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4234
Mailing Address - Country:US
Mailing Address - Phone:713-686-9194
Mailing Address - Fax:713-686-9413
Practice Address - Street 1:4411 DACOMA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8611
Practice Address - Country:US
Practice Address - Phone:713-686-9194
Practice Address - Fax:713-686-9413
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2022-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX4593106H00000X
TX552483364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146371304Medicaid