Provider Demographics
NPI:1104063742
Name:BLAKEMAN, TOMMY L (MS)
Entity type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:L
Last Name:BLAKEMAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:TOMMY
Other - Middle Name:L
Other - Last Name:BLAKEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LCDC
Mailing Address - Street 1:710 CHANDLER CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3617
Mailing Address - Country:US
Mailing Address - Phone:972-548-5570
Mailing Address - Fax:972-548-5579
Practice Address - Street 1:2600 AVENUE K
Practice Address - Street 2:SUITE
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5306
Practice Address - Country:US
Practice Address - Phone:972-548-5570
Practice Address - Fax:972-548-5579
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6787101YA0400X
TX63187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health