Provider Demographics
NPI:1154730547
Name:BLACKBURN, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 WALLACE AVE
Mailing Address - Street 2:#2
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2240
Mailing Address - Country:US
Mailing Address - Phone:502-475-0600
Mailing Address - Fax:
Practice Address - Street 1:2518 WALLACE AVE
Practice Address - Street 2:#2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2240
Practice Address - Country:US
Practice Address - Phone:502-475-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health