Individual
JACOB BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 KENSINGTON AVE STE 203, MISSOULA, MT 59801-5670
(406) 201-6501
Mailing address
800 KENSINGTON AVE STE 203, MISSOULA, MT 59801-5670
(406) 201-6501
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
BBH-LAC-LIC-33154
MT
1041C0700X
Clinical Social Worker
BBH-SWLC-LIC-48355
MT
Other
Enumeration date
10/31/2019
Last updated
09/08/2023
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