Provider Demographics
NPI:1760498174
Name:BLAIR, NANCY CAROL (LPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CAROL
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 BROADWAY RD N
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-6272
Mailing Address - Country:US
Mailing Address - Phone:731-967-8803
Mailing Address - Fax:731-967-8784
Practice Address - Street 1:844 NATCHEZ TRACE DR N
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-4144
Practice Address - Country:US
Practice Address - Phone:731-967-8803
Practice Address - Fax:731-967-8784
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC 1504104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4007722OtherBCBS PROVIDER NUMBER
TN572449000Medicaid