Provider Demographics
NPI:1750392726
Name:BLAKEY, LORI ELLEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ELLEN
Last Name:BLAKEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:ELLEN
Other - Last Name:GARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-922-7000
Mailing Address - Fax:210-590-1380
Practice Address - Street 1:5542 WALZEM RD
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78218-2103
Practice Address - Country:US
Practice Address - Phone:210-922-7000
Practice Address - Fax:210-590-1380
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX260421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0007MXOtherBLUE CROSS BLUE SHIELD
TX612019Medicare PIN
TX0007MXOtherBLUE CROSS BLUE SHIELD