Blair, Melissa M.
Blair, Melissa M. is an sole proprietor health care provider with primary practice located at 3005 James Ave S , Minneapolis MN 55408-2533. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is her primary health care specialty. Blair, Melissa M. can be contacted via phone (612) 227-2829.Contact Information
Primary practice address
3005 James Ave S
Minneapolis MN 55408-2533
Phone: (612) 227-2829
Fax: (612) 377-7501
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Clinical Child & Adolescent | 103TC2200X | LP3550 | Minnesota |
Behavioral Health & Social Service Providers / Psychologist | 103T00000X |
Profile Details
NPI number | 1962570242 |
---|---|
LBN Legal business name | Blair, Melissa M. |
Credentials | PH.D. |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Dec 2nd, 2006 |
Last updated | Nov 10th, 2022 - about 3 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1962570242 | NPPES |
Minnesota | MEDICAID | 040161700 | |
Minnesota | Other | 6173818 | |
Minnesota | Other | 117T6NA OR 114T7NA | |
Minnesota | Other | 20258-11 | |
Minnesota | Other | 141774 |
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