Provider Demographics
NPI:1053625301
Name:BLOUNT, TABATHA HOPE (PHD)
Entity type:Individual
Prefix:DR
First Name:TABATHA
Middle Name:HOPE
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:MC7977
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-9000
Mailing Address - Fax:
Practice Address - Street 1:11212 HWY 151
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4498
Practice Address - Country:US
Practice Address - Phone:210-450-9900
Practice Address - Fax:210-450-9901
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2013-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX36234103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX312629401Medicaid
TX268109YK00Medicare PIN