MEDICARE: BLANCHE HANDUNGE KHAN PHD LPC LCDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	178	TX
2	101YP2500X	Professional Counselor	13025	TX
3	103T00000X	Psychologist	CERTIFICATION	TX
4	103TA0400X	Addiction (Substance Use Disorder) Psychologist	5660	TX
5	101YP1600X	Pastoral Counselor
6	103TF0200X	Forensic Psychologist
7	103TP2701X	Group Psychotherapy Psychologist
8	103T00000X	Psychologist
9	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10008730	OTHER		AMERIGROUP

General Provider Information

NPI Number	:	1174619357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLANCHE HANDUNGE KHAN PHD LPC LCDC

Provider Business Mailing Address
First Line	:	10036 RIDGECORAL DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77038
Country	:	US
Telephone Number	:	713-520-5492
Fax Number	:	713-365-0133

Provider Business Practice Location Address
First Line	:	B KHAN
Second Line	:	2990 RICHMOND AVE SUITE 207
City	:	HOUSTON
State	:	TX
Zip	:	77098
Country	:	US
Telephone Number	:	713-520-5492
Fax Number	:	713-365-0133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	09/11/2025

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