Provider Demographics
NPI:1821468729
Name:BLAIR, JENNIFER J (MA, LPCA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 CORPORATE DR
Mailing Address - Street 2:STE. 101
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-5432
Mailing Address - Country:US
Mailing Address - Phone:859-971-2585
Mailing Address - Fax:859-971-7594
Practice Address - Street 1:861 CORPORATE DR
Practice Address - Street 2:STE. 101
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-5432
Practice Address - Country:US
Practice Address - Phone:859-971-2585
Practice Address - Fax:859-971-7594
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid