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Individual
JACOB BLACKWELL
Active
Individual
JACOB BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
BBH-LAC-LIC-33154
MT
1041C0700X
Clinical Social Worker
BBH-SWLC-LIC-48355
MT
Other
Enumeration date
10/31/2019
Last updated
09/08/2023
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