Provider Demographics
NPI:1356495006
Name:BLAIR, ERIC SHANE (MS)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:SHANE
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 TWIN OAKS RD W
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-7744
Mailing Address - Country:US
Mailing Address - Phone:318-484-6850
Mailing Address - Fax:318-484-6506
Practice Address - Street 1:242 WEST SHAMROCK STREET
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-484-6850
Practice Address - Fax:318-484-6506
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
LA1472101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health