Individual
JACK BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2373 VINEYARD PL, BOULDER, CO 80304-0649
(720) 275-2756
Mailing address
2373 VINEYARD PL, BOULDER, CO 80304-0649
(720) 275-2756
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
NLC0103233
CO
Other
Enumeration date
08/15/2017
Last updated
07/21/2022
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