Individual
ELIZABETH RANDELL BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
20174 FRONT ST NE, POULSBO, WA 98370-7445
(404) 426-0486
(404) 426-0486
Mailing address
20174 FRONT ST NE, POULSBO, WA 98370-7445
(404) 426-0486
(404) 426-0486
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LF60554394
WA
106H00000X
Marriage & Family Therapist
MFT000939
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104049568
NPI
GA
05
—
125233048A
—
GA
Enumeration date
04/11/2007
Last updated
05/01/2018
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