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General NPI Number Information
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NPI Number | 1639539364
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Entity Type | Organization
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Legal Business Name | BLANK SLATE THERAPY
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 7000 PARKWOOD BLVD SUITE G400
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City | FRISCO
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State | TX
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Zip | 75034-7406
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Country | US
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Telephone | 972-345-4565
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Fax |
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Provider Business Mailing Address
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Address Line | 7000 PARKWOOD BLVD SUITE G400
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City | FRISCO
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State | TX
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Zip | 75034-7406
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Country | US
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Telephone | 972-345-4565
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | REBECCA HOUSER
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Credential | LPC, RPT
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Telephone | 972-345-4565
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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 | 68617
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License Number State | TX
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