Individual
JAY BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPCC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CTL0223091
NM
101YP2500X
Professional Counselor
Primary
CTB-2026-0236
NM
175T00000X
Peer Specialist
1241
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1241
OFFICE OF PEER RECOVERY AND ENGAGEMENT
NM
01
—
CTB20260236
NMRLD
NM
01
—
CTL0223091
NM REGULATION AND LICENSING DEPARTMENT
NM
Enumeration date
11/10/2021
Last updated
03/20/2026
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