Provider Demographics
NPI:1487376463
Name:BLACKBURN, JAHN (CMHCI)
Entity type:Individual
Prefix:
First Name:JAHN
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:CMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 N VERNAL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2100
Mailing Address - Country:US
Mailing Address - Phone:435-789-1305
Mailing Address - Fax:435-781-0331
Practice Address - Street 1:185 N VERNAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2100
Practice Address - Country:US
Practice Address - Phone:435-789-1305
Practice Address - Fax:435-781-0331
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health