Provider Demographics
NPI:1326443318
Name:BLACKWELL, MARILYN (CMHC, LPCI)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:CMHC, LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 NE HIGHWAY 99W
Mailing Address - Street 2:STE H
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-2757
Mailing Address - Country:US
Mailing Address - Phone:503-474-0194
Mailing Address - Fax:
Practice Address - Street 1:1900 NE HIGHWAY 99W
Practice Address - Street 2:STE H
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2757
Practice Address - Country:US
Practice Address - Phone:503-474-0194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR3388101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor