Healthcare Provider Details

I. General information

NPI: 1588154348
Provider Name (Legal Business Name): TAYLOR LOUISE BLACKBURN LPCC, MED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24803 DETROIT RD UNIT E
WESTLAKE OH
44145-2553
US

IV. Provider business mailing address

214 SEDONA DR
SUMMERVILLE SC
29486-2462
US

V. Phone/Fax

Practice location:
  • Phone: 440-723-2765
  • Fax:
Mailing address:
  • Phone: 330-933-6525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2103606
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2404698
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: