Individual
MR. PETER RUSSELL BLACKMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1140 SHIRLEY RD, BUNKIE, LA 71322-1545
(318) 346-8001
(318) 346-8005
Mailing address
2260 VALLEY STREET PO BOX 205, MANSURA, LA 71350-0205
(318) 346-8001
(318) 346-8005
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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