Provider Demographics
NPI:1467228031
Name:BLACKBURN, JUSTIN (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9310 BARTON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-2641
Mailing Address - Country:US
Mailing Address - Phone:469-644-3837
Mailing Address - Fax:
Practice Address - Street 1:6730 HORIZON RD STE C
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-2081
Practice Address - Country:US
Practice Address - Phone:469-812-5621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health