Individual
JULIE S. BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
13947 ANNAPOLIS CT, CEDAR LAKE, IN 46303-7805
(815) 556-9471
Mailing address
9715 W 133RD AVE UNIT 834, CEDAR LAKE, IN 46303-7752
(815) 556-9471
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180009503
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180009503
ILLINOIS LICENSED CLINICAL PROFESSIONAL COUNSELOR LICENSE
IL
01
—
39003693A
INDIANA LMHP (LICENSED MENTAL HEALTH PROFESSIONAL)
IN
Enumeration date
01/08/2015
Last updated
05/31/2023
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