Healthcare Provider Details

I. General information

NPI: 1669721825
Provider Name (Legal Business Name): BLAIR JOSEPH A'HEARN M.DIV., M.A., LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 PARKWOOD LN NE
CEDAR RAPIDS IA
52402-1027
US

IV. Provider business mailing address

1501 PARKWOOD LN NE
CEDAR RAPIDS IA
52402-1027
US

V. Phone/Fax

Practice location:
  • Phone: 319-899-3913
  • Fax:
Mailing address:
  • Phone: 319-899-3913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001551
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: