Provider Demographics
NPI:1477617355
Name:CARR, BLAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:
Last Name:CARR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 SPICEWOOD SPRINGS RD STE C8
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8658
Mailing Address - Country:US
Mailing Address - Phone:512-627-3583
Mailing Address - Fax:512-692-3727
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD STE C8
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8658
Practice Address - Country:US
Practice Address - Phone:512-452-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32045103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B9163Medicare ID - Type Unspecified