MEDICARE: MR. DAN K BLAIR MA

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	101YM0800X	Mental Health Counselor		IL
2	101YM0800X	Mental Health Counselor		IL

General Provider Information

NPI Number	:	1891866141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAN K BLAIR MA

Provider Business Mailing Address
First Line	:	7115 VIRGINIA RD
Second Line	:	SUITE 110
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3112
Country	:	US
Telephone Number	:	815-276-3947
Fax Number	:	815-356-8975

Provider Business Practice Location Address
First Line	:	7115 VIRGINIA RD
Second Line	:	SUITE 110
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3112
Country	:	US
Telephone Number	:	815-276-3947
Fax Number	:	815-356-8975

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. DAN K BLAIR MA” Practice Location

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