Provider Demographics
NPI:1770752941
Name:BLACKBURN, JAMIE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18333 EGRET BAY BLVD
Mailing Address - Street 2:STE 540
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3860
Mailing Address - Country:US
Mailing Address - Phone:832-864-6000
Mailing Address - Fax:832-864-6001
Practice Address - Street 1:18333 EGRET BAY BLVD
Practice Address - Street 2:STE 540
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3860
Practice Address - Country:US
Practice Address - Phone:832-864-6000
Practice Address - Fax:832-864-6001
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62285101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional