Jacob Blackwell

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

BBH-LAC-LIC-33154 Issued in MT

Practice address

800 Kensington Ave Ste 203
Missoula, MT 59801-5670

Phone

(406) 201-6501

NPI assigned

Oct 31, 2019

Last updated

Sep 8, 2023By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Blackwell Behavioral Health

  • Addiction (Substance Use Disorder) Counselor
  • Missoula, MT
  • NPI 1104326974
  NPD

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

{
    "created_epoch": "1572480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694131200000",
    "number": "1871137034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 KENSINGTON AVE STE 203",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598015670",
            "telephone_number": "406-201-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 KENSINGTON AVE STE 203",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598015670",
            "telephone_number": "406-201-6501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-31",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MT",
            "license": "BBH-LAC-LIC-33154",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MT",
            "license": "BBH-SWLC-LIC-48355",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Blackwellbehavioralhealth@gmail.com",
            "affiliation": "Y",
            "endpointDescription": "Business Email",
            "affiliationName": "Blackwell Behavioral Health",
            "address_1": "800 Kensington Ave Ste 203",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598015670",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Diana L. Bjorgen, PHD
• Black Bear Naturopathic Clinic, PC
• Riley Davis Blackhurst, DDS
• Russell D Blackhurst, D.M.D.
• Blackwell Behavioral Health
• Kaylee Virginia Blackwell, LAC
• Katherine Blaedow
• Donald Robert Blair, DC
• Jolynn Marie Blakeley, BCBA, LBA
• Benjamin Blakely, PT, DPT

• Addiction (Substance Use Disorder) Counselor in Missoula, MT
• Providers in Missoula, MT by specialty
• Addiction (Substance Use Disorder) Counselor in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; 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.