Provider Demographics
NPI:1962503102
Name:BLAIR, LEITA MAE (LPC, LMFT)
Entity Type:Individual
Prefix:DR
First Name:LEITA
Middle Name:MAE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 N. COLLINS SUITE 409
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2665
Mailing Address - Country:US
Mailing Address - Phone:817-410-9006
Mailing Address - Fax:817-410-9006
Practice Address - Street 1:2007 N. COLLINS SUITE 409
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2665
Practice Address - Country:US
Practice Address - Phone:817-410-9006
Practice Address - Fax:817-410-9006
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4505101YP2500X
TX1748106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist