MEDICARE: GWENDOLYN YVONNE BLACKNELL 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	10653	TX

General Provider Information

NPI Number	:	1962707570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN YVONNE BLACKNELL LCDC

Provider Business Mailing Address
First Line	:	3207 BROADWAY ST
Second Line	:	APT. 3207
City	:	HOUSTON
State	:	TX
Zip	:	77017-2320
Country	:	US
Telephone Number	:	281-991-8668
Fax Number	:	713-236-0120

Provider Business Practice Location Address
First Line	:	3207 BROADWAY ST
Second Line	:	APT. 3207
City	:	HOUSTON
State	:	TX
Zip	:	77017-2320
Country	:	US
Telephone Number	:	281-991-8668
Fax Number	:	713-236-0120

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

Provider Enumeration Date	:	01/13/2011
Last Update Date	:	04/18/2014

Similar Medicare Providers

1407957061 — ANGEL DAVID SANCHEZ DDS
Practice Location Address:

3201 BROADWAY
HOUSTON, TX
77017-2320

Practice Phone: 713-643-2500
Practice Fax: 713-643-2797

1184849291 — MRS. AIDE JACIVE RUBIO DDS
Practice Location Address:

3201 BROADWAY
HOUSTON, TX
77017-2320

Practice Phone: 713-643-2500
Practice Fax: 713-643-2797

1912346685 — AANCHAL CHANDRA D.D.S.
Practice Location Address:

3201 BROADWAY ST
HOUSTON, TX
77017-2320

Practice Phone: 713-643-2500
Practice Fax: 713-643-2797

1497130512 — JACQUELINE CLARY D.M.D, M.S.D.
Practice Location Address:

3201 BROADWAY ST
HOUSTON, TX
77017-2320

Practice Phone: 713-643-2500
Practice Fax:

1578228268 — A&A DENTAL KIDS, PLLC
Practice Location Address:

3201 BROADWAY ST
HOUSTON, TX
77017-2320

Practice Phone: 713-643-2500
Practice Fax:

1356346613 — THOMAS MAURICE WEIL DDS
Practice Location Address:

2450 FONDREN RD , STE 320
HOUSTON, TX
77063-2320

Practice Phone: 713-783-5560
Practice Fax: 713-783-7333

Directions to “ GWENDOLYN YVONNE BLACKNELL LCDC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.