Provider Demographics
NPI:1699202291
Name:BLAIR, AMY MICHELLE (LMHC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:13061 SUNDAY LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-8024
Mailing Address - Country:US
Mailing Address - Phone:360-630-9943
Mailing Address - Fax:
Practice Address - Street 1:22790 BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-8023
Practice Address - Country:US
Practice Address - Phone:360-630-9943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60448382101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health