Provider Demographics
NPI:1689282444
Name:J. BLAIR CANO, PSYD, MSCP
Entity Type:Organization
Organization Name:J. BLAIR CANO, PSYD, MSCP
Other - Org Name:J. BLAIR CANO, PSYD, MSCP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HETRICK-CANO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MSCP
Authorized Official - Phone:719-964-8953
Mailing Address - Street 1:1938 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6715
Mailing Address - Country:US
Mailing Address - Phone:719-964-8953
Mailing Address - Fax:
Practice Address - Street 1:77 3RD ST # 400
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8179
Practice Address - Country:US
Practice Address - Phone:719-964-8953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty