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General NPI Number Information
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NPI Number | 1700030582
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Entity Type | Organization
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Legal Business Name | BLAIR&ASSOCIATES, A PROFESSIONAL PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 11/06/2008
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | 12021 WILSHIRE BLVD #430
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City | LOS ANGELES
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State | CA
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Zip | 90025-1206
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Country | US
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Telephone | 310-866-6414
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Fax | 310-826-4706
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Provider Business Mailing Address
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Address Line | 12021 WILSHIRE BLVD #430
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City | LOS ANGELES
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State | CA
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Zip | 90025-1206
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Country | US
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Telephone | 310-866-6414
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | CASSIDY F BLAIR
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Credential | PSY.D.
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Telephone | 310-866-6414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY22022
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License Number State | CA
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