Individual
ETHAN BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, PLPC
Contact information
Practice address
724 N 22ND ST, SAINT JOSEPH, MO 64506-2604
(816) 341-1501
Mailing address
724 N 22ND ST, SAINT JOSEPH, MO 64506-2604
(816) 341-1501
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2023025977
MO
Other
Enumeration date
06/28/2023
Last updated
06/28/2023
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