Provider Demographics
NPI:1801827464
Name:BLAIR, TERRY L (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:BLAIR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216
Mailing Address - Country:US
Mailing Address - Phone:615-228-1706
Mailing Address - Fax:615-320-8751
Practice Address - Street 1:115 28TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1411
Practice Address - Country:US
Practice Address - Phone:615-862-2269
Practice Address - Fax:615-320-8751
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0009041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN81483698Medicare UPIN
TN3137104Medicare UPIN
TN5171096Medicare UPIN
TN3694286Medicare ID - Type UnspecifiedMEDICARE
TN132418Medicare UPIN