Provider Demographics
NPI:1346317419
Name:BLAIR, NATALIE DANIELLE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:DANIELLE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:DANIELLE
Other - Last Name:GILLASPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:1701 MISSION AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7102
Mailing Address - Country:US
Mailing Address - Phone:760-967-4475
Mailing Address - Fax:760-966-3827
Practice Address - Street 1:1701 MISSION AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7102
Practice Address - Country:US
Practice Address - Phone:760-967-4475
Practice Address - Fax:760-966-3827
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46138106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist