Black, William Jesse

Black, William Jesse is an individual health care provider with primary practice located at 271 Cypress Drive , Barstow CA 92311. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Black, William Jesse can be contacted via phone (507) 732-4136.

Contact Information

Primary practice address
271 Cypress Drive Barstow CA 92311
Phone: (507) 732-4136
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 4476 Minnesota
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 300555 Minnesota

Profile Details

NPI number 1972716314
LBN Legal business name Black, William Jesse
Credentials LICSW, LADC, BCD
Entity Individual
Sole proprietor 1 No
Enumeration date May 8th, 2007
Last updated Jun 21st, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972716314 NPPES
Minnesota MEDICAID 1972716314

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