Provider Demographics
NPI:1609614932
Name:JARVIS, BLAIR
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:JARVIS
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 1:18807 N SUGAR MAPLE CIR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-2886
Mailing Address - Country:US
Mailing Address - Phone:832-869-9943
Mailing Address - Fax:
Practice Address - Street 1:18807 N SUGAR MAPLE CIR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-2886
Practice Address - Country:US
Practice Address - Phone:832-869-9943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst