Individual
HEATHER BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
3450 HIGHWAY 80 W, JACKSON, MS 39209-7201
(601) 321-2400
(601) 321-2476
Mailing address
3450 HIGHWAY 80 W, JACKSON, MS 39209-7201
(601) 321-2400
(601) 321-2476
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT1034
LA
Other
Enumeration date
03/24/2011
Last updated
03/24/2011
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