Provider Demographics
NPI:1891866141
Name:BLAIR, DAN K (MA)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:K
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 VIRGINIA RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3112
Mailing Address - Country:US
Mailing Address - Phone:815-276-3947
Mailing Address - Fax:815-356-8975
Practice Address - Street 1:7115 VIRGINIA RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3112
Practice Address - Country:US
Practice Address - Phone:815-276-3947
Practice Address - Fax:815-356-8975
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health