Provider Demographics
NPI:1174619357
Name:KHAN, BLANCHE HANDUNGE (PHD LPC LCDC)
Entity type:Individual
Prefix:
First Name:BLANCHE
Middle Name:HANDUNGE
Last Name:KHAN
Suffix:
Gender:F
Credentials:PHD LPC LCDC
Other - Prefix:
Other - First Name:BLANCHE
Other - Middle Name:PAMELA
Other - Last Name:HANDUNGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10036 RIDGECORAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77038
Mailing Address - Country:US
Mailing Address - Phone:713-520-5492
Mailing Address - Fax:713-365-0133
Practice Address - Street 1:B KHAN
Practice Address - Street 2:2990 RICHMOND AVE SUITE 207
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098
Practice Address - Country:US
Practice Address - Phone:713-520-5492
Practice Address - Fax:713-365-0133
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178101YA0400X
TX13025101YP2500X
TXCERTIFICATION103T00000X
TX5660103TA0400X
101YP1600X, 103TF0200X, 103TP2701X, 103T00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
10008730OtherAMERIGROUP