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NPI Code Detail

MEDICARE: MR. TERRY BLAKENEY

MEDICARE: MR. TERRY BLAKENEY
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCADC-I 01197NV
2171M00000XCase Manager/Care CoordinatorCADC-I 01197NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427336494
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TERRY BLAKENEY
Provider Business Mailing Address
First Line : 3936 SAVOY CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-0316
Country : US
Telephone Number : 702-757-5801
Fax Number :
Provider Business Practice Location Address
First Line : 1200 HARRIS SPRINGS ROAD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89124-7817
Country : US
Telephone Number : 702-872-5382
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2011
Last Update Date : 07/01/2013

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