Provider Demographics
NPI:1093926917
Name:BLAIR, ROBERT A (LCPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:BLAIR
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12882 BLUEBELL AVE.
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-6368
Mailing Address - Country:US
Mailing Address - Phone:847-515-8578
Mailing Address - Fax:
Practice Address - Street 1:12882 BLUEBELL AVE.
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-6368
Practice Address - Country:US
Practice Address - Phone:847-515-8578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional