Provider Demographics
NPI:1174197677
Name:FALCON, BLAIRE ALEXANDRA
Entity Type:Individual
Prefix:
First Name:BLAIRE
Middle Name:ALEXANDRA
Last Name:FALCON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30419 DENOUX RD
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-9240
Mailing Address - Country:US
Mailing Address - Phone:225-323-6754
Mailing Address - Fax:
Practice Address - Street 1:1028 E WORTHY ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4367
Practice Address - Country:US
Practice Address - Phone:504-399-9851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician