Basic Information
| Provider Information | |||||||||
| NPI: | 1477617355 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARR | ||||||||
| FirstName: | BLAINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4131 SPICEWOOD SPRINGS RD STE C8 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787598658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126273583 | ||||||||
| FaxNumber: | 5126923727 | ||||||||
| Practice Location | |||||||||
| Address1: | 4131 SPICEWOOD SPRINGS RD STE C8 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787598658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124520381 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 01/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 32045 | TX | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.