Provider Demographics
NPI:1265642490
Name:BLAIR'S COUNSELING SERVICE
Entity Type:Organization
Organization Name:BLAIR'S COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, FAPA, CGP,CRS
Authorized Official - Phone:850-297-2190
Mailing Address - Street 1:PO BOX 12697
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-2697
Mailing Address - Country:US
Mailing Address - Phone:850-297-2190
Mailing Address - Fax:850-385-6598
Practice Address - Street 1:2652 EGRET LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0542
Practice Address - Country:US
Practice Address - Phone:850-297-2190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 233106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ-1073OtherBLUE CROSS & BLUE SHIELD