Provider Demographics
NPI:1396405429
Name:BLACKBURN, ZAILYN PRADA (MATS)
Entity type:Individual
Prefix:
First Name:ZAILYN
Middle Name:PRADA
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:MATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 S VAUGHN WAY STE 550
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3538
Mailing Address - Country:US
Mailing Address - Phone:720-295-7167
Mailing Address - Fax:
Practice Address - Street 1:3190 S VAUGHN WAY STE 550
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3538
Practice Address - Country:US
Practice Address - Phone:720-295-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health