Timothy Alan Blackburn

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MC61574268 Issued in WA

Practice address

4 Nickerson St Ste 300
Seattle, WA 98109-1699

Phone

(888) 364-5977

NPI assigned

Mar 5, 2025

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Emily Program PC

  • Community/Behavioral Health Agency
  • Seattle, WA
  • NPI 1154696698
  NPD (past)
• The Emily Program, PC

  • Psychiatric Residential Treatment Facility
  • Seattle, WA
  • NPI 1871948257
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1741132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1013715150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1295 BANDANA BLVD W",
            "address_2": "STE 210",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "55108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 NICKERSON ST STE 300",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981091699",
            "telephone_number": "888-364-5977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "TIMOTHY",
        "middle_name": "ALAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-03-05",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC61574268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor McCallum Black, MD
• Allyson Marie Blackburn
• Barbara J Blackburn, MC. LMHC
• Jack Archer Blackburn, LMP
• Rebecca Blackburn, LMP
• Kathryn E Blacken, PT
• Dana Blackham, M.D.
• Lauren Villasenor Blackham, ND
• Matthew David Blackham
• Heidi R. Blackie, OTR/L, CHT

• All providers in Seattle, WA
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.