MEDICARE: BLAKE ALAN THOMAS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	92990	TX

General Provider Information

NPI Number	:	1366301590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAKE ALAN THOMAS LPC

Provider Business Mailing Address
First Line	:	1400 N COIT RD STE 706
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-6658
Country	:	US
Telephone Number	:	940-220-9307
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 N COIT RD STE 706
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-6658
Country	:	US
Telephone Number	:	940-220-9307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	02/03/2026

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