Healthcare Provider Details

I. General information

NPI: 1538678503
Provider Name (Legal Business Name): AMBER BLACKBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 LINWOOD DR STE C
PARAGOULD AR
72450-7110
US

IV. Provider business mailing address

5301 LINWOOD DR STE C
PARAGOULD AR
72450-7110
US

V. Phone/Fax

Practice location:
  • Phone: 870-600-9001
  • Fax: 870-474-8140
Mailing address:
  • Phone: 870-600-9001
  • Fax: 870-474-8140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2108003
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: