Provider Demographics
NPI:1114638137
Name:BLACKBURN, REES (RBT)
Entity Type:Individual
Prefix:MR
First Name:REES
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 QUEENSWOOD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-2942
Mailing Address - Country:US
Mailing Address - Phone:972-467-9268
Mailing Address - Fax:
Practice Address - Street 1:520 NEWPORT CENTER DR STE 550
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7020
Practice Address - Country:US
Practice Address - Phone:855-673-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-22-247854106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty