MEDICARE: TAYLOR LOUISE BLACKBURN LPCC, MED

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
1	101YP2500X	Professional Counselor	E.2404698	OH
2	101YM0800X	Mental Health Counselor	C.2103606	OH

General Provider Information

NPI Number	:	1588154348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR LOUISE BLACKBURN LPCC, MED

Provider Business Mailing Address
First Line	:	214 SEDONA DR
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29486-2462
Country	:	US
Telephone Number	:	330-933-6525
Fax Number	:

Provider Business Practice Location Address
First Line	:	24803 DETROIT RD UNIT E
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-2553
Country	:	US
Telephone Number	:	440-723-2765
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2018
Last Update Date	:	10/04/2024

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