Provider Demographics
NPI:1679202626
Name:BLAIS, ROBERT PHELPS (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PHELPS
Last Name:BLAIS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 HILLTOP RD APT 205
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-3476
Mailing Address - Country:US
Mailing Address - Phone:805-680-8941
Mailing Address - Fax:
Practice Address - Street 1:1185 HILLTOP RD APT 205
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-3476
Practice Address - Country:US
Practice Address - Phone:805-680-8941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT42365106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist