Provider Demographics
NPI:1790112779
Name:SCHMAUTZ, BLAIR F
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:F
Last Name:SCHMAUTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 116TH AVE NE
Mailing Address - Street 2:STE 224
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3045
Mailing Address - Country:US
Mailing Address - Phone:425-954-5360
Mailing Address - Fax:
Practice Address - Street 1:1611 116TH AVE NE
Practice Address - Street 2:STE 224
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3045
Practice Address - Country:US
Practice Address - Phone:425-954-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALC 60526883101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional