Provider Demographics
NPI:1588206718
Name:BLANCHARD, IRIS MARIE (LPC LICDC)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:MARIE
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:LPC LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 IMOGENE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-5208
Mailing Address - Country:US
Mailing Address - Phone:937-626-6481
Mailing Address - Fax:
Practice Address - Street 1:2025 GERMANTOWN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3345
Practice Address - Country:US
Practice Address - Phone:937-626-6481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0900075101YM0800X
OH011018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health