Healthcare Provider Details

I. General information

NPI: 1477617355
Provider Name (Legal Business Name): BLAINE CARR PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 01/09/2021
Certification Date: 01/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 SPICEWOOD SPRINGS RD STE C8
AUSTIN TX
78759-8658
US

IV. Provider business mailing address

4131 SPICEWOOD SPRINGS RD STE C8
AUSTIN TX
78759-8658
US

V. Phone/Fax

Practice location:
  • Phone: 512-452-0381
  • Fax:
Mailing address:
  • Phone: 512-627-3583
  • Fax: 512-692-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32045
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: