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General NPI Number Information
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NPI Number | 1184837486
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Entity Type | Individual
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Provider Name | MARY BETH BLAIR LPC
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 02/10/2019
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Provider Practice Location Address
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Address Line | 4800 WHITESPORT CIR SW STE 2
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City | HUNTSVILLE
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State | AL
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Zip | 35801-6443
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Country | US
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Telephone | 256-533-9393
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Fax | 256-533-9690
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Provider Business Mailing Address
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Address Line | 5750A SOUTHLAND DR
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City | MOBILE
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State | AL
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Zip | 36693-3316
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Country | US
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Telephone | 251-450-5901
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Fax | 251-662-7297
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2567
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2567
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License Number State | AL
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