Jack Blackwell

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

NLC0103233 Issued in CO

Practice address

2373 Vineyard PL
Boulder, CO 80304-0649

Phone

(720) 275-2756

NPI assigned

Aug 15, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1417473190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2373 VINEYARD PL",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803040649",
            "telephone_number": "720-275-2756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2373 VINEYARD PL",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803040649",
            "telephone_number": "720-275-2756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "JACK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "NLC0103233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Black
• Tracey Black
• Adriana Blacker
• Juliet Blackfeather
• Isabelle Marie Blackwell, MA
• Cheryl Allyson Blackwood, PA-C
• Clint Brian Blackwood, MD
• Liberty Blades
• Francie Blair, MSW, LSW, ADDC
• Blake Higgins Therapy (Blake Higgins Therapy LLC)

• Mental Health Counselor in Boulder, CO
• Providers in Boulder, CO by specialty
• Mental Health Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.