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General NPI Number Information
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NPI Number | 1699581330
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Entity Type | Individual
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Provider Name | IAN DAVIS BLAIR
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Gender | Male
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Dates
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Enumeration Date | 12/07/2024
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Last Update Date | 12/07/2024
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Provider Practice Location Address
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Address Line | 10090 HIGHWAY 9 STE 6
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City | BEN LOMOND
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State | CA
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Zip | 95005-9251
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Country | US
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Telephone | 831-704-6851
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Fax |
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Provider Business Mailing Address
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Address Line | 151 ARCHER WAY
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City | BEN LOMOND
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State | CA
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Zip | 95005-9530
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Country | US
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Telephone | 831-334-4964
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 15411
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License Number State | CA
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