Individual
JEFFREY BLACKMON BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3450 HIGHWAY 80 W, JACKSON, MS 39209
(601) 321-2400
(601) 985-5174
Mailing address
4684 OLD JACKSON RD, TERRY, MS 39170-9214
(769) 798-9194
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018209
—
MS
Enumeration date
06/04/2018
Last updated
08/13/2018
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