Healthcare Provider Details

I. General information

NPI: 1811057789
Provider Name (Legal Business Name): SHAWNE ANN BLACKBURN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5916 ANAHEIM AVE NE STE A
ALBUQUERQUE NM
87113-1894
US

IV. Provider business mailing address

5916 ANAHEIM AVE NE STE A
ALBUQUERQUE NM
87113-1894
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-6314
  • Fax: 505-275-0296
Mailing address:
  • Phone: 505-291-6314
  • Fax: 505-275-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: