Provider Demographics
NPI:1851144745
Name:GRIESE BLAIR, EMILEE A
Entity Type:Individual
Prefix:MRS
First Name:EMILEE
Middle Name:A
Last Name:GRIESE BLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29145 ROAD H
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-9154
Mailing Address - Country:US
Mailing Address - Phone:970-570-5074
Mailing Address - Fax:
Practice Address - Street 1:29145 ROAD H
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-9154
Practice Address - Country:US
Practice Address - Phone:970-570-5074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020528101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health