MEDICARE: HOLEN BLACKBURN

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	101YM0800X	Mental Health Counselor	39002659A	IN

General Provider Information

NPI Number	:	1063805380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLEN BLACKBURN

Provider Business Mailing Address
First Line	:	1000 SAGAMORE PKWY N
Second Line	:	#207
City	:	LAFAYETTE
State	:	IN
Zip	:	47904-2461
Country	:	US
Telephone Number	:	765-446-0006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 SAGAMORE PKWY N
Second Line	:	#207
City	:	LAFAYETTE
State	:	IN
Zip	:	47904-2461
Country	:	US
Telephone Number	:	765-446-0006
Fax Number	:

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

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	04/09/2017

Similar Medicare Providers

1396121182 — HOLEN BLACKBURN COUNSELING SERVICES, LLC
Practice Location Address:

1000 SAGAMORE PKWY N , #207
LAFAYETTE, IN
47904-2461

Practice Phone: 765-446-0006
Practice Fax:

1841768496 — MRS. MARILYN CORONA BROWN LCSW
Practice Location Address:

321 TRAVIS ST STE 10B
LAFAYETTE, LA
70503-2461

Practice Phone: 337-486-3542
Practice Fax:

1679542369 — TERESA M LEVERETT DO
Practice Location Address:

200 LAFAYETTE RD STE 4
NORTH HAMPTON, NH
03862-2461

Practice Phone: 603-373-7000
Practice Fax: 603-319-8154

1770994048 — ALFRED'S MEDICAL STAFFING AGENCY
Practice Location Address:

321 TRAVIS ST
LAFAYETTE, LA
70503-2461

Practice Phone: 337-534-8968
Practice Fax: 337-534-8938

1114494234 — HERITAGE CARE INC
Practice Location Address:

321 TRAVIS ST
LAFAYETTE, LA
70503-2461

Practice Phone: 337-806-9171
Practice Fax: 337-534-8076

1700536653 — DR. ALFREDO EQUIGUA JR. MD
Practice Location Address:

1702 LAFAYETTE ST
LAREDO, TX
78041-2461

Practice Phone: 956-795-8100
Practice Fax:

Directions to “ HOLEN BLACKBURN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.