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General NPI Number Information
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NPI Number | 1467373100
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Entity Type | Individual
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Provider Name | MRS. STACIE L BLANKENSHIP
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Gender | Female
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Dates
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Enumeration Date | 07/21/2026
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Last Update Date | 07/21/2026
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Provider Practice Location Address
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Address Line | 5280 OLD RELIANCE RD
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City | BRYAN
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State | TX
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Zip | 77808-1525
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Country | US
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Telephone | 979-229-7735
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Fax |
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Provider Business Mailing Address
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Address Line | 9661 JINKINS RD
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City | NORTH ZULCH
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State | TX
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Zip | 77872-6837
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Country | US
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Telephone | 979-229-7735
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 97866
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License Number State | TX
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