Active NPI
Holen Blackburn
- Mental Health Counselor
- Lafayette, IN
National Provider Identifier
1063805380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 39002659A
- Practice address
- 1000 Sagamore Pkwy N
#207
Lafayette, IN 47904-2461 - Phone
- (765) 446-0006
- NPI assigned
- Mar 11, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 39002659A | IN | Primary |
Addresses
Primary practice location
1000 Sagamore Pkwy N
#207
Lafayette, IN 47904-2461
Mailing address
1000 Sagamore Pkwy N
#207
Lafayette, IN 47904-2461
Phone (765) 446-0006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39002659A | IN | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holen Blackburn Counseling Services, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Lafayette, IN
- NPI 1396121182
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491696000000",
"number": "1063805380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 SAGAMORE PKWY N",
"address_2": "#207",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479042461",
"telephone_number": "765-446-0006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 SAGAMORE PKWY N",
"address_2": "#207",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479042461",
"telephone_number": "765-446-0006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN",
"first_name": "HOLEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-11",
"last_updated": "2017-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "39002659A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.