Provider Demographics
NPI:1588154348
Name:BLACKBURN, TAYLOR LOUISE (LPCC, MED)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LOUISE
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:LPCC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SEDONA DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-2462
Mailing Address - Country:US
Mailing Address - Phone:330-933-6525
Mailing Address - Fax:
Practice Address - Street 1:24803 DETROIT RD UNIT E
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2553
Practice Address - Country:US
Practice Address - Phone:440-723-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2404698101YP2500X
OHC.2103606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health