Blaine, Jonathan W

Blaine, Jonathan W is an individual health care provider with primary practice located at 11059 E Bethany Dr , Aurora CO 80014-2622. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Blaine, Jonathan W can be contacted via phone (303) 617-2392.

Contact Information

Primary practice address
11059 E Bethany Dr Aurora CO 80014-2622
Phone: (303) 617-2392
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 2444 Colorado

Profile Details

NPI number 1902980261
LBN Legal business name Blaine, Jonathan W
Credentials PSY.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902980261 NPPES
Colorado MEDICAID 88623769

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