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General NPI Number Information
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NPI Number | 1063625481
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Entity Type | Individual
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Provider Name | MICHAEL EVAN BLAIR LMFT
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 90 NORTH MAIN
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City | STERLING
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State | UT
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Zip | 84665
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Country | US
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Telephone | 435-703-0756
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Fax |
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Provider Business Mailing Address
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Address Line | 387 EAST 450 SOUTH
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City | MANTI
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State | UT
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Zip | 84642
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Country | US
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Telephone | 143-570-3075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1157703902
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License Number State | UT
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