Provider Demographics
NPI:1528313491
Name:HOWARD, BLAKE (MA)
Entity type:Individual
Prefix:MS
First Name:BLAKE
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 WALLINGWOOD DR
Mailing Address - Street 2:BLDG 1, SUITE 124
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6900
Mailing Address - Country:US
Mailing Address - Phone:512-761-7451
Mailing Address - Fax:
Practice Address - Street 1:2525 WALLINGWOOD DR
Practice Address - Street 2:BLDG 1, SUITE 124
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6900
Practice Address - Country:US
Practice Address - Phone:512-761-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201436106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist