Basic Information
| Provider Information | |||||||||
| NPI: | 1669838074 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAIR | ||||||||
| FirstName: | JOANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 LAROUSSINI ST | ||||||||
| Address2: | |||||||||
| City: | WESTWEGO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700944248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042416006 | ||||||||
| FaxNumber: | 5042416007 | ||||||||
| Practice Location | |||||||||
| Address1: | 251 LAROUSSINI ST | ||||||||
| Address2: | |||||||||
| City: | WESTWEGO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042416006 | ||||||||
| FaxNumber: | 5042416007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2016 | ||||||||
| LastUpdateDate: | 07/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.