Provider Demographics
NPI:1891776373
Name:BLACKBOURN, SHEILA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:BLACKBOURN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:LOVELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:7794 S GOLDEN BELL DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-0088
Mailing Address - Country:US
Mailing Address - Phone:575-706-6611
Mailing Address - Fax:
Practice Address - Street 1:7794 S GOLDEN BELL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-0088
Practice Address - Country:US
Practice Address - Phone:575-706-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ158461041C0700X
NMI052611041C0700X
NM3173721041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18256066Medicaid
NM18256066Medicaid