Provider Demographics
NPI:1215982806
Name:BLAIR, JAMES DOUGLAS (EDD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DOUGLAS
Last Name:BLAIR
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:DOUGLAS
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDD
Mailing Address - Street 1:212 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6562
Mailing Address - Country:US
Mailing Address - Phone:337-356-9596
Mailing Address - Fax:
Practice Address - Street 1:300 RUE BEAUREGARD
Practice Address - Street 2:BLDG J
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8511
Practice Address - Country:US
Practice Address - Phone:337-520-0653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA231101YP2500X
LA545106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist