Provider Demographics
NPI:1346486065
Name:BLAIR, DAVID LEE (LCSW, CACIII)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:BLAIR
Suffix:
Gender:M
Credentials:LCSW, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4891 INDEPENDENCE ST
Mailing Address - Street 2:SUITE 165
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6752
Mailing Address - Country:US
Mailing Address - Phone:303-456-0600
Mailing Address - Fax:303-456-0607
Practice Address - Street 1:4891 INDEPENDENCE ST
Practice Address - Street 2:SUITE 165
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6752
Practice Address - Country:US
Practice Address - Phone:303-456-0600
Practice Address - Fax:303-456-0607
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO986003101YM0800X
CO6050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health