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General NPI Number Information
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NPI Number | 1518104306
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Entity Type | Organization
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Legal Business Name | BLAIN AND ASSOCIATES, PC
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Dates
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Enumeration Date | 01/15/2009
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Last Update Date | 01/15/2009
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Provider Practice Location Address
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Address Line | 135 N. GREENLEAF SUITE 212
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City | GURNEE
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State | IL
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Zip | 60031
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Country | US
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Telephone | 847-791-5928
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Fax | 847-223-0887
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Provider Business Mailing Address
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Address Line | PO BOX 855
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City | GRAYSLAKE
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State | IL
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Zip | 60030-0855
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Country | US
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Telephone | 847-791-5928
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Fax | 847-223-0887
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GERALD BLAIN
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Credential | MS, LCPC
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Telephone | 847-791-5928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180-002267
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License Number State | IL
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