1265642490 NPI number — BLAIR'S COUNSELING SERVICE

Table of content: (NPI 1265642490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265642490 NPI number — BLAIR'S COUNSELING SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLAIR'S COUNSELING SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265642490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12697
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32317-2697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-297-2190
Provider Business Mailing Address Fax Number:
850-385-6598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2652 EGRET LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308-0542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-297-2190
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BLAIR
Authorized Official First Name:
MAUDINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
850-297-2190

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MT 233 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Z-1073 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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