Healthcare Provider Details

I. General information

NPI: 1336907922
Provider Name (Legal Business Name): SHAWNE A BLACKBURN LPCC COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6604 BEAU CHENE NE
ALBUQUERQUE NM
87111-6500
US

IV. Provider business mailing address

6604 BEAU CHENE NE
ALBUQUERQUE NM
87111-6500
US

V. Phone/Fax

Practice location:
  • Phone: 505-263-3900
  • Fax:
Mailing address:
  • Phone: 505-263-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHAWNE A. BLACKBURN
Title or Position: OWNER/REGISTERED AGENT
Credential: LPCC
Phone: 505-263-3900