Provider Demographics
NPI:1871160333
Name:BLAIR, JEANETTE (AMFT)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 LIVE OAK BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4028
Mailing Address - Country:US
Mailing Address - Phone:530-682-5261
Mailing Address - Fax:
Practice Address - Street 1:1002 LIVE OAK BLVD STE D
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4028
Practice Address - Country:US
Practice Address - Phone:530-682-5261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130545106H00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist