Provider Demographics
NPI:1396121182
Name:HOLEN BLACKBURN COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:HOLEN BLACKBURN COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC, LMHC
Authorized Official - Phone:765-446-0006
Mailing Address - Street 1:1000 SAGAMORE PKWY N
Mailing Address - Street 2:#207
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2461
Mailing Address - Country:US
Mailing Address - Phone:765-446-0006
Mailing Address - Fax:
Practice Address - Street 1:1000 SAGAMORE PKWY N
Practice Address - Street 2:#207
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2461
Practice Address - Country:US
Practice Address - Phone:765-446-0006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002659A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health