Provider Demographics
NPI:1720245236
Name:HARTMAN BLACKBURN, KATHLEEN M (LPCC, NCC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:HARTMAN BLACKBURN
Suffix:
Gender:F
Credentials:LPCC, NCC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:114 WELLINGTON PL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1736
Mailing Address - Country:US
Mailing Address - Phone:513-621-3600
Mailing Address - Fax:513-621-3613
Practice Address - Street 1:114 WELLINGTON PL
Practice Address - Street 2:SUITE 2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1736
Practice Address - Country:US
Practice Address - Phone:513-621-3600
Practice Address - Fax:513-621-3613
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004170101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist