Edward L Blackburn

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

25232 Code Rd
Southfield, MI 48033-5806

Phone

(248) 409-4185

NPI assigned

Nov 8, 2021

Last updated

Nov 8, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

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

{
    "created_epoch": "1636329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1033874722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25232 CODE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480335806",
            "telephone_number": "248-867-9889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25232 CODE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480335806",
            "telephone_number": "248-409-4185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "EDWARD",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-08",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Black & White Look Optical Corp
• Black and White Look Optical Corporation
• Black Male Therapist LLC
• Sabrina Diana Black, LLPC
• Brittany Denise Blackburn, REGISTERED NURSE
• Jason Barry Blackburn, CRNA
• Meloneze Renee Blackman
• Amiyah Kyrah Denise Blackshear
• Sharon Blackshire-Tubie, FNP-BC
• Natalie Blair

• Counselor in Southfield, MI
• Providers in Southfield, MI by specialty
• Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; 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.