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General NPI Number Information
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NPI Number | 1114415643
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Entity Type | Individual
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Provider Name | LORENA BLANK
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Gender | Female
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 1368 N ZARAGOZA RD STE A
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City | EL PASO
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State | TX
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Zip | 79936-8030
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Country | US
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Telephone | 915-307-6721
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Fax | 915-581-7980
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Provider Business Mailing Address
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Address Line | 11857 FRANCIS SCOBEE DR
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City | EL PASO
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State | TX
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Zip | 79936-5084
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Country | US
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Telephone | 915-215-0214
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Fax | 915-581-7980
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 75459
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License Number State | TX
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