Organization
JONATHAN M. BLAIR PHD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN MATTHEW BLAIR PHD (LICENSED PSYCHOLOGIST)
(774) 239-8605
Entity
Organization
Contact information
Practice address
5123 W ST JOE HWY, SUITE 103, LANSING, MI 48917-4093
(517) 323-4099
Mailing address
2909 S CAMBRIDGE RD, LANSING, MI 48911-1024
(774) 239-8605
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301014658
MI
103TC0700X
Clinical Psychologist
6301014658
MI
103TF0000X
Family Psychologist
6301014658
MI
Other
Enumeration date
04/12/2013
Last updated
04/12/2013
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