Mark Daniel Blackhurst, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY28115 Issued in CA

Practice address

3034 E Herndon Ave
Fresno, CA 93720-0300

Phone

(559) 321-0883

NPI assigned

Jul 19, 2011

Last updated

May 19, 2025By the provider in NPPES

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Access Psychology Services PC

  • Psychologist
  • San Diego, CA
  • NPI 1558752931
  Medicare reassignment NPD
• California Department of Corrections &Rehabilitation

  • Rural Health Clinic/Center
  • Chowchilla, CA
  • NPI 1073710398
  NPD (past)
• State of California

  dba California Correctional Health Care Services

  • Prison Health Clinic/Center
  • Chowchilla, CA
  • NPI 1316322647
  NPD (past)

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

{
    "created_epoch": "1311033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747612800000",
    "number": "1760770192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21633 AVENUE 24",
            "city": "CHOWCHILLA",
            "state": "CA",
            "postal_code": "936109650",
            "telephone_number": "559-665-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3034 E HERNDON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937200300",
            "telephone_number": "559-321-0883"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21633 Avenue 24",
            "address_purpose": "LOCATION",
            "city": "Chowchilla",
            "state": "CA",
            "postal_code": "936109650",
            "country_code": "US",
            "telephone_number": "559-665-6100 x5218",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKHURST",
        "first_name": "MARK",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-19",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY28115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stanley Markay Black, RN, BSN, MPA
• Faith J Blackburn, PA-C
• Jessie Relisa Blackburn
• John Devin Blackburn, O.D.
• Asheria Blackford
• Latisha Ann Blackmon
• Ginger Blackwell
• Max Ryan Blackwell
• Raschel Lynnette Blackwell
• Asha Blades, DPM

• Clinical Psychologist in Fresno, CA
• Providers in Fresno, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.