Provider Demographics
NPI:1487202511
Name:BLACKMON, DEBBIE (MA)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:HOCKLEY
Mailing Address - State:TX
Mailing Address - Zip Code:77447-0083
Mailing Address - Country:US
Mailing Address - Phone:713-516-5165
Mailing Address - Fax:
Practice Address - Street 1:14034 HOOPER RD
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77047-5212
Practice Address - Country:US
Practice Address - Phone:713-516-5165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6081103TS0200X
TX12367103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool