Provider Demographics
NPI:1821337247
Name:BLAKE, CYNTHIA (LPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E CASTELLANO DR STE C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6436
Mailing Address - Country:US
Mailing Address - Phone:915-777-2979
Mailing Address - Fax:888-974-1081
Practice Address - Street 1:105 E CASTELLANO DR STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6436
Practice Address - Country:US
Practice Address - Phone:915-777-2979
Practice Address - Fax:888-974-1081
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67183101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health