| Walisha M. Blackmore M.ed., Lpc | |
|
2100 19th St Port Arthur TX 77640-3859 | |
| (409) 344-2790 | |
| Not Available |
| Full Name | Walisha M. Blackmore M.ed., Lpc |
|---|---|
| Speciality | Counselor |
| Location | 2100 19th St, Port Arthur, Texas |
| Authorized Official Name and Position | Walisha Blackmore (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 4093442790 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Walisha M. Blackmore M.ed., Lpc 2100 19th St Port Arthur TX 77640-3859 Ph: () - | Walisha M. Blackmore M.ed., Lpc 2100 19th St Port Arthur TX 77640-3859 Ph: (409) 344-2790 |
| NPI Number | 1649674219 |
|---|---|
| Provider Enumeration Date | 10/10/2014 |
| Last Update Date | 10/10/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649674219 | NPI | - | NPPES |
| 028371503 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 15296 (Texas) | Primary |
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