Provider Demographics
NPI:1821148537
Name:GARNER, BLAIR K (LCSW)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:K
Last Name:GARNER
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 1:2235 E 25TH ST STE 185
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7539
Mailing Address - Country:US
Mailing Address - Phone:208-522-1904
Mailing Address - Fax:208-522-8847
Practice Address - Street 1:2235 E 25TH ST STE 185
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7539
Practice Address - Country:US
Practice Address - Phone:208-522-1904
Practice Address - Fax:208-522-8847
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-5821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010015892OtherBLUE SHIELD PROVIDER NUMB
IDL5824OtherBLUE CROSS PROVIDER NUMBE
IDL5824OtherBLUE CROSS PROVIDER NUMBE