Provider Demographics
NPI:1184995532
Name:BLAIR, LAURA ANNE (LPC, MFTC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANNE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LPC, MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1817
Mailing Address - Country:US
Mailing Address - Phone:970-773-7925
Mailing Address - Fax:970-399-3648
Practice Address - Street 1:300 STAFFORD LN STE 30248
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2247
Practice Address - Country:US
Practice Address - Phone:970-414-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0014179101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional