Healthcare Provider Details

I. General information

NPI: 1356855209
Provider Name (Legal Business Name): DON BLYTHE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DONALD L BLYTHE LPC

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22420 PRIEST RD
ELMENDORF TX
78112-6086
US

IV. Provider business mailing address

22420 PRIEST RD
ELMENDORF TX
78112-6086
US

V. Phone/Fax

Practice location:
  • Phone: 210-667-3740
  • Fax:
Mailing address:
  • Phone: 210-667-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number74169
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: