Provider Demographics
NPI:1932682598
Name:BLAIR, JENA D (MFT-INTERN)
Entity Type:Individual
Prefix:MS
First Name:JENA
Middle Name:D
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MFT-INTERN
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:DENNELLE
Other - Last Name:DREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 US HWY 94 A SOUTH
Mailing Address - Street 2:STE. G 701
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-7007
Mailing Address - Country:US
Mailing Address - Phone:775-575-2144
Mailing Address - Fax:775-575-2100
Practice Address - Street 1:415 US HWY 94 A SOUTH
Practice Address - Street 2:STE. G 701
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-7007
Practice Address - Country:US
Practice Address - Phone:775-575-2144
Practice Address - Fax:775-575-2100
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
NVMI0954101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty