Provider Demographics
NPI:1013486208
Name:BLACKBURN, TERESA ELAINE (LPC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ELAINE
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 S AVALON DR
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3706
Mailing Address - Country:US
Mailing Address - Phone:740-461-4829
Mailing Address - Fax:
Practice Address - Street 1:200 HIGH TOWER BLVD STE 306
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-1135
Practice Address - Country:US
Practice Address - Phone:740-461-4829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional