Provider Demographics
NPI:1285785196
Name:BLAIR, TANA M (LPC, LMFT, LCDC)
Entity type:Individual
Prefix:MS
First Name:TANA
Middle Name:M
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LPC, LMFT, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 WELLS FARGO DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-4044
Mailing Address - Country:US
Mailing Address - Phone:281-893-4239
Mailing Address - Fax:936-273-1293
Practice Address - Street 1:530 WELLS FARGO DR
Practice Address - Street 2:SUITE 220
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-4044
Practice Address - Country:US
Practice Address - Phone:281-893-4239
Practice Address - Fax:936-273-1293
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6235101YA0400X
TX1553101YP2500X
TX1760106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist