Provider Demographics
NPI:1366251613
Name:BLANTON, KATELYN (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:BLANTON
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2348
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:TX
Mailing Address - Zip Code:76430-8015
Mailing Address - Country:US
Mailing Address - Phone:325-762-0088
Mailing Address - Fax:
Practice Address - Street 1:412 W PARK AVE
Practice Address - Street 2:
Practice Address - City:DEVINE
Practice Address - State:TX
Practice Address - Zip Code:78016-2530
Practice Address - Country:US
Practice Address - Phone:325-762-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94974101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health