Provider Demographics
NPI:1568840015
Name:BLACKBURN, ANTHONY P (LCSW)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 W CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4329
Mailing Address - Country:US
Mailing Address - Phone:903-462-4600
Mailing Address - Fax:903-298-0046
Practice Address - Street 1:1029 W CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4329
Practice Address - Country:US
Practice Address - Phone:903-462-4600
Practice Address - Fax:903-298-0046
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12517101YA0400X
TX506231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)