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NPI Code Detail

MEDICARE: MRS. REBECCA LYNN BLACKMON LPC

MEDICARE: MRS. REBECCA LYNN BLACKMON LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLPC.0015892CO

General Provider Information

NPI Number : 1295409647
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBECCA LYNN BLACKMON LPC
Provider Business Mailing Address
First Line : 1923 GUARDIAN WAY
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80919-3811
Country : US
Telephone Number : 303-883-7022
Fax Number :
Provider Business Practice Location Address
First Line : 1923 GUARDIAN WAY
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80919-3811
Country : US
Telephone Number : 303-883-7022
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2021
Last Update Date : 09/13/2022

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