Provider Demographics
NPI:1700030582
Name:BLAIR&ASSOCIATES, A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:BLAIR&ASSOCIATES, A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CASSIDY
Authorized Official - Middle Name:F
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-866-6414
Mailing Address - Street 1:12021 WILSHIRE BLVD
Mailing Address - Street 2:#430
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1206
Mailing Address - Country:US
Mailing Address - Phone:310-866-6414
Mailing Address - Fax:
Practice Address - Street 1:12021 WILSHIRE BLVD
Practice Address - Street 2:#430
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1206
Practice Address - Country:US
Practice Address - Phone:310-866-6414
Practice Address - Fax:310-826-4706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22022103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty