Provider Demographics
NPI:1649653239
Name:BLAIR, TODD (LMHC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:BLAIR
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 S 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4012
Mailing Address - Country:US
Mailing Address - Phone:509-823-7087
Mailing Address - Fax:
Practice Address - Street 1:2807 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903-1285
Practice Address - Country:US
Practice Address - Phone:509-823-7087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60884356101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health