Active NPI
Kaitlin Emily Blackwell, LPC
- Professional Counselor
- Mineral Wells, TX
National Provider Identifier
1962965079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 74841
- Practice address
- 416 NE 4TH Ave
Mineral Wells, TX 76067-4424 - Phone
- (940) 445-2076
- NPI assigned
- Apr 8, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 74841 | TX | Primary |
Addresses
Primary practice location
416 NE 4TH Ave
Mineral Wells, TX 76067-4424
Mailing address
416 NE 4TH Ave
Mineral Wells, TX 76067-4424
Phone (940) 445-2076
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 |
|---|---|---|---|
| 74841 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554681600000",
"number": "1962965079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "416 NE 4TH AVE",
"city": "MINERAL WELLS",
"state": "TX",
"postal_code": "760674424",
"telephone_number": "940-445-2076"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "416 NE 4TH AVE",
"city": "MINERAL WELLS",
"state": "TX",
"postal_code": "760674424",
"telephone_number": "940-445-2076"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKWELL",
"first_name": "KAITLIN",
"middle_name": "EMILY",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-08",
"last_updated": "2019-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "74841",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mineral Wells, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.