Provider Demographics
NPI:1851662852
Name:BLAIR K. GARNER, PA
Entity Type:Organization
Organization Name:BLAIR K. GARNER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:K
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-522-1904
Mailing Address - Street 1:2235 E 25TH ST
Mailing Address - Street 2:SUITE 185
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7519
Mailing Address - Country:US
Mailing Address - Phone:208-522-1904
Mailing Address - Fax:208-522-8847
Practice Address - Street 1:2235 E 25TH ST
Practice Address - Street 2:SUITE 185
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7519
Practice Address - Country:US
Practice Address - Phone:208-522-1904
Practice Address - Fax:208-522-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-582251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health