MEDICARE: DR. MEGAN NICOLE BLAIR PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY.0006299	CO
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1669821203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGAN NICOLE BLAIR PHD

Provider Business Mailing Address
First Line	:	5684 FLICKA DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-4211
Country	:	US
Telephone Number	:	970-312-1365
Fax Number	:

Provider Business Practice Location Address
First Line	:	5684 FLICKA DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-4211
Country	:	US
Telephone Number	:	970-312-1365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2016
Last Update Date	:	11/29/2023

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