Basic Information
| Provider Information | |||||||||
| NPI: | 1356576672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAIR | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | BARBARA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5735 CLEAR STREAM WAY | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430816652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407046069 | ||||||||
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| Practice Location | |||||||||
| Address1: | 624 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431303903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406870042 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2009 | ||||||||
| LastUpdateDate: | 05/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E.0501228 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.