Provider Demographics
NPI:1538899356
Name:BLAIR, ERICA LEIGH (PCLC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LEIGH
Last Name:BLAIR
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5226
Mailing Address - Country:US
Mailing Address - Phone:406-284-1260
Mailing Address - Fax:
Practice Address - Street 1:1800 W KOCH ST STE 5
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-1301
Practice Address - Country:US
Practice Address - Phone:406-284-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT55609101YM0800X
MT56740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health