Provider Demographics
NPI:1912206509
Name:BLACKBURN, JOY (NCSP)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-3616
Mailing Address - Country:US
Mailing Address - Phone:317-856-5265
Mailing Address - Fax:317-856-2156
Practice Address - Street 1:5275 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-3616
Practice Address - Country:US
Practice Address - Phone:317-856-5265
Practice Address - Fax:317-856-2156
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10167526103TS0200X
IN340061851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical