Provider Demographics
NPI:1528290244
Name:BLAIR, MONET
Entity type:Individual
Prefix:
First Name:MONET
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60387 LATHAM TRL
Mailing Address - Street 2:
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-2812
Mailing Address - Country:US
Mailing Address - Phone:760-318-5835
Mailing Address - Fax:760-228-1614
Practice Address - Street 1:60387 LATHAM TRL
Practice Address - Street 2:
Practice Address - City:JOSHUA TREE
Practice Address - State:CA
Practice Address - Zip Code:92252-2812
Practice Address - Country:US
Practice Address - Phone:760-318-5835
Practice Address - Fax:760-228-1614
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF80251106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist