Provider Demographics
NPI:1841501640
Name:BLAIR, CLYDE AMEL III (LMFT)
Entity type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:AMEL
Last Name:BLAIR
Suffix:III
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 GARDEN ST
Mailing Address - Street 2:APT. 6
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1071
Mailing Address - Country:US
Mailing Address - Phone:805-302-8474
Mailing Address - Fax:
Practice Address - Street 1:721 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2905
Practice Address - Country:US
Practice Address - Phone:805-302-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47961106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist