Provider Demographics
NPI:1568770071
Name:BLACKBURN, ADRIENNE L (T-LMHC)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:L
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:T-LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W BROADWAY ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-6065
Mailing Address - Country:US
Mailing Address - Phone:575-393-0692
Mailing Address - Fax:575-393-0692
Practice Address - Street 1:215 W BROADWAY ST
Practice Address - Street 2:SUITE #1
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-6065
Practice Address - Country:US
Practice Address - Phone:575-393-0692
Practice Address - Fax:575-393-0692
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0126771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health