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General NPI Number Information
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NPI Number | 1992339188
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Entity Type | Individual
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Provider Name | BLAKE M THOMPSON LPC-I, LCDC, CRC
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Gender | Male
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 1221 W BEN WHITE BLVD STE B300
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City | AUSTIN
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State | TX
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Zip | 78704-7192
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Country | US
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Telephone | 877-800-5722
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Fax |
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Provider Business Mailing Address
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Address Line | 2423 WILLIAMS DR STE 107
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City | GEORGETOWN
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State | TX
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Zip | 78628-3269
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Country | US
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Telephone | 877-800-5722
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 14832
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 81624
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License Number State | TX
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