Provider Demographics
NPI:1598040735
Name:PALACIOS, BLANCA (LPC-A)
Entity Type:Individual
Prefix:MRS
First Name:BLANCA
Middle Name:
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5955 ALPHA RD # 1392
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-1121
Mailing Address - Country:US
Mailing Address - Phone:469-423-5671
Mailing Address - Fax:
Practice Address - Street 1:5955 ALPHA RD # 1392
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-1121
Practice Address - Country:US
Practice Address - Phone:469-423-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89451101YP2500X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner