Provider Demographics
NPI:1285608026
Name:EGAN-BLACKWOOD, KAREN A (LMHC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:EGAN-BLACKWOOD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 ELK SPRING DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-1723
Mailing Address - Country:US
Mailing Address - Phone:813-610-8923
Mailing Address - Fax:813-631-7131
Practice Address - Street 1:JAMES A. HALEY VETERANS ADMINISTRATION HOSPITAL
Practice Address - Street 2:13000 BRUCE B. DOWNS BOULEVARD
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-610-8923
Practice Address - Fax:813-631-7131
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5126101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health