Provider Demographics
NPI:1821216987
Name:BLACKBURN, DESIREE ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:ANN
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 MEADOWLARK DR
Mailing Address - Street 2:
Mailing Address - City:EAST HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59635-3116
Mailing Address - Country:US
Mailing Address - Phone:406-438-7015
Mailing Address - Fax:
Practice Address - Street 1:3675 MEADOWLARK DR
Practice Address - Street 2:
Practice Address - City:EAST HELENA
Practice Address - State:MT
Practice Address - Zip Code:59635
Practice Address - Country:US
Practice Address - Phone:406-438-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT748-LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical