Provider Demographics
NPI:1972577484
Name:BLAIR, SYDNEY P (LCSW)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:P
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 FOX FARM RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-6411
Mailing Address - Country:US
Mailing Address - Phone:406-761-4995
Mailing Address - Fax:
Practice Address - Street 1:228 17TH AVE NW
Practice Address - Street 2:CENTER FOR MENTAL HEALTH/CMR HIGH SCHOOL
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1807
Practice Address - Country:US
Practice Address - Phone:406-268-6126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT389 LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000071295OtherBLUE CROSS/SHIELD OF MONT