Peter Russell Blackman Jr.

Primary specialty

CounselorTaxonomy code 101Y00000X

License

1544761 Issued in LA

Practice address

1140 Shirley Rd
Bunkie, LA 71322-1545

Phone

(318) 346-8001

Fax

(318) 346-8005

NPI assigned

Jan 19, 2016

Last updated

Jan 19, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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": "1453161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453161600000",
    "number": "1609233907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2260 VALLEY STREET PO BOX 205",
            "city": "MANSURA",
            "state": "LA",
            "postal_code": "713500205",
            "telephone_number": "318-346-8001",
            "fax_number": "318-346-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 SHIRLEY RD",
            "city": "BUNKIE",
            "state": "LA",
            "postal_code": "713221545",
            "telephone_number": "318-346-8001",
            "fax_number": "318-346-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKMAN",
        "first_name": "PETER",
        "middle_name": "RUSSELL",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-19",
        "last_updated": "2016-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "LA",
            "license": "1544761",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "LA",
            "license": "1544761",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1544761",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rochelle Baldoz
• Thesia Batiste
• Bayou Vista Nursing and Rehab Center
• Lashaitrend Berry
• Bio-Medical Applications of Louisiana, LLC (Bma Bunkie)
• Angela Bonton
• Margaret Brasseaux, M.S., CCC-SLP
• Glenda Browndodson
• Bunkie City Drug, Inc.
• Bunkie Dentistry

• Counselor in Bunkie, LA
• Providers in Bunkie, LA by specialty
• Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2016; 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.