Individual
TEGAN BLACKBIRD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH D
Contact information
Practice address
108 S MAIN ST, MANHEIM, PA 17545-1602
(717) 964-8897
Mailing address
40 PHEASANT CT, ELIZABETHTOWN, PA 17022-9206
(717) 964-8897
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PS004895L
PA
103TC0700X
Clinical Psychologist
Primary
PS004895L
PA
Other
Enumeration date
07/22/2006
Last updated
08/10/2020
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