Provider Demographics
NPI:1972225829
Name:BLACKBURN, DANIEL E
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BEHAVIOR FRONTIERS, LLC 227 NORTH LOOP 1604 EAST #150
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:210-761-3504
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:BEHAVIOR FRONTIERS, LLC 227 NORTH LOOP 1604 EAST #150
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232
Practice Address - Country:US
Practice Address - Phone:210-761-3504
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician