Shane Blackburn
Individual provider Active NPI Counselor · Morehead, KY
NPI 1215415237 · NPPES record last updated Aug 1, 2018
Key facts
- NPI
- 1215415237
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 321 E Main St
Morehead, KY 40351-1671 - Phone
- (606) 784-4161
- Fax
- (606) 783-9952
- NPI assigned
- Aug 1, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
321 E Main St
Morehead, KY 40351-1671
Mailing address
PO Box 790
Ashland, KY 41105-0790
Phone (606) 329-8588
Other providers in Morehead, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.