Provider Demographics
NPI:1932962271
Name:CORDOVA, BLYTHE MONROE (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:BLYTHE
Middle Name:MONROE
Last Name:CORDOVA
Suffix:
Gender:M
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26310 OAK RIDGE DR STE 35
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3777
Mailing Address - Country:US
Mailing Address - Phone:346-386-7045
Mailing Address - Fax:
Practice Address - Street 1:26310 OAK RIDGE DR STE 35
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3777
Practice Address - Country:US
Practice Address - Phone:346-386-7045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94122101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor