Provider Demographics
NPI:1740771369
Name:BLACKBOURN, LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:BLACKBOURN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:CHRISTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2961 YARMOUTH GREENWAY DR
Mailing Address - Street 2:ST 2
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5809
Mailing Address - Country:US
Mailing Address - Phone:608-709-9672
Mailing Address - Fax:608-416-1535
Practice Address - Street 1:2961 YARMOUTH GREENWAY DR
Practice Address - Street 2:ST 2
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5809
Practice Address - Country:US
Practice Address - Phone:608-709-9672
Practice Address - Fax:608-416-1535
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3905101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor