Provider Demographics
NPI:1912335399
Name:BLAIR, PERRY (MED, LPCC)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BRECKENRIDGE LN STE 205
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3879
Mailing Address - Country:US
Mailing Address - Phone:502-742-4014
Mailing Address - Fax:502-709-4264
Practice Address - Street 1:214 BRECKENRIDGE LN STE 205
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3879
Practice Address - Country:US
Practice Address - Phone:502-742-4014
Practice Address - Fax:502-709-4264
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCPCC00218886101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health