Provider Demographics
NPI:1548000219
Name:BLAIR, BROOK WHITNEY
Entity type:Individual
Prefix:
First Name:BROOK
Middle Name:WHITNEY
Last Name:BLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6718 POPLAR FOREST LN APT SUITE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3586
Mailing Address - Country:US
Mailing Address - Phone:502-445-2431
Mailing Address - Fax:
Practice Address - Street 1:6718 POPLAR FOREST LN APT SUITE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-3586
Practice Address - Country:US
Practice Address - Phone:502-445-2431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY291286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional