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General NPI Number Information
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NPI Number | 1437613684
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Entity Type | Individual
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Provider Name | BLAIR WELLMON BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | ALOHA BEHAVIORAL PRACTICE 25 KANEOHE BAY DRIVE
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City | KAILUA
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State | HI
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Zip | 96734
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Country | US
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Telephone | 808-388-1683
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Fax |
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Provider Business Mailing Address
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Address Line | 2047 ANENA ST
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City | KAILUA
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State | HI
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Zip | 96734-6802
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Country | US
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Telephone | 845-542-1827
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-18-53119
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BACB403898
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License Number State | HI
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