Provider Demographics
NPI:1730471616
Name:BLENDEN DEVRIES, TANYA ELISE (MS, LPC, LCDC, NCC)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:ELISE
Last Name:BLENDEN DEVRIES
Suffix:
Gender:F
Credentials:MS, LPC, LCDC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional