MEDICARE: DEBBIE BLACKMON MA

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	103TS0200X	School Psychologist	6081	TX
2	103T00000X	Psychologist	12367	TX

General Provider Information

NPI Number	:	1487202511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE BLACKMON MA

Provider Business Mailing Address
First Line	:	PO BOX 83
Second Line	:
City	:	HOCKLEY
State	:	TX
Zip	:	77447-0083
Country	:	US
Telephone Number	:	713-516-5165
Fax Number	:

Provider Business Practice Location Address
First Line	:	14034 HOOPER RD
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77047-5212
Country	:	US
Telephone Number	:	713-516-5165
Fax Number	:

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

Provider Enumeration Date	:	09/02/2019
Last Update Date	:	09/02/2019

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Directions to “ DEBBIE BLACKMON MA” Practice Location

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