Provider Demographics
NPI:1801392972
Name:BLAIR, ERIKA (MA, LPC, RPT)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MA, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3518
Mailing Address - Country:US
Mailing Address - Phone:512-461-7521
Mailing Address - Fax:
Practice Address - Street 1:4118 WILLIAMS DR STE 101
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1335
Practice Address - Country:US
Practice Address - Phone:512-461-7521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74792101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74792OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS
T3729OtherASSOCIATION FOR PLAY THERAPY