Individual
BRENTT BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9412 BIG HORN BLVD STE 6, ELK GROVE, CA 95758-1101
(916) 402-9007
Mailing address
9412 BIG HORN BLVD STE 6, ELK GROVE, CA 95758-1101
(916) 402-9007
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
06/29/2021
Last updated
09/15/2021
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