Provider Demographics
NPI:1851402267
Name:BLACKBURN, ART (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ART
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:ART
Other - Middle Name:
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:875 ARLINGTON HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8159
Mailing Address - Country:US
Mailing Address - Phone:615-776-5393
Mailing Address - Fax:
Practice Address - Street 1:1616 WESTGATE CIR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8019
Practice Address - Country:US
Practice Address - Phone:615-844-6114
Practice Address - Fax:615-844-6115
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical