Individual
KELLY LANE BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
708 W FOREST AVE, JACKSON, TN 38301-3901
(731) 425-4930
Mailing address
1804 HIGHWAY 45 BYP, SUITE 604, JACKSON, TN 38305-4436
(731) 660-8759
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1706
TN
103TR0400X
Rehabilitation Psychologist
1706
TN
Other
Enumeration date
07/13/2006
Last updated
07/31/2009
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