Provider Demographics
NPI:1033856224
Name:BART, BLAINE PATRICK (MS, LMHC)
Entity Type:Individual
Prefix:MR
First Name:BLAINE
Middle Name:PATRICK
Last Name:BART
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 W SAINT THOMAS MORE WAY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-8252
Mailing Address - Country:US
Mailing Address - Phone:509-847-3302
Mailing Address - Fax:
Practice Address - Street 1:2311 W SAINT THOMAS MORE WAY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-8252
Practice Address - Country:US
Practice Address - Phone:509-934-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61225884101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional