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1750951109
BRENTT BLACKMON
ELK GROVE, CA
NPI
1750951109
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101Y00000X Counselor
Additional Taxonomies
106S00000X Behavior Technician
Enumeration Date
2021-06-29
Last Update Date
2021-09-15
Business Address
BRENTT BLACKMON
9412 BIG HORN BLVD STE 6
ELK GROVE, CA 95758-1101
Phone number: 916-402-9007
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Mailing Address
BRENTT BLACKMON
9412 BIG HORN BLVD STE 6
ELK GROVE, CA 95758-1101
Phone number: 916-402-9007
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