Provider Demographics
NPI:1265783294
Name:BLAIR, JESSICA LYNN (LPCC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 STOVALL RD
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42127-9431
Mailing Address - Country:US
Mailing Address - Phone:270-670-6985
Mailing Address - Fax:
Practice Address - Street 1:222 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2441
Practice Address - Country:US
Practice Address - Phone:270-629-6836
Practice Address - Fax:270-629-6837
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
KY163058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid