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Individual
MR. PETER RUSSELL BLACKMAN JR.
Active
Individual
MR. PETER RUSSELL BLACKMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1544761
LA
101YM0800X
Mental Health Counselor
1544761
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1544761
—
LA
Enumeration date
01/19/2016
Last updated
01/19/2016
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