Provider Demographics
NPI:1154011922
Name:MEAD, BLAIR (LPC)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:MEAD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 DUTCH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-1629
Mailing Address - Country:US
Mailing Address - Phone:814-460-8107
Mailing Address - Fax:
Practice Address - Street 1:7687 RED BUD TRL
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:PA
Practice Address - Zip Code:16415-1250
Practice Address - Country:US
Practice Address - Phone:814-460-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015654101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health