Healthcare Provider Details

I. General information

NPI: 1831002781
Provider Name (Legal Business Name): TERRY BLAIR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23611 CHAGRIN BLVD STE 103
BEACHWOOD OH
44122-5540
US

IV. Provider business mailing address

23611 CHAGRIN BLVD STE 103
BEACHWOOD OH
44122-5540
US

V. Phone/Fax

Practice location:
  • Phone: 844-316-7599
  • Fax: 607-208-7289
Mailing address:
  • Phone: 844-316-7599
  • Fax: 607-208-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberQMHS
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: