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NPI Code Detail

MEDICARE: JEREMY BLACKSHIRE MA, LPC, LMHP, LSATP

MEDICARE: JEREMY BLACKSHIRE MA, LPC, LMHP, LSATP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor0701008802VA

General Provider Information

NPI Number : 1982232179
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY BLACKSHIRE MA, LPC, LMHP, LSATP
Provider Business Mailing Address
First Line : 20276 TIMBERLAKE RD STE A
Second Line :
City : LYNCHBURG
State : VA
Zip : 24502-7214
Country : US
Telephone Number : 434-319-5528
Fax Number :
Provider Business Practice Location Address
First Line : 20276 TIMBERLAKE RD STE A
Second Line :
City : LYNCHBURG
State : VA
Zip : 24502-7214
Country : US
Telephone Number : 434-319-5528
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2020
Last Update Date : 08/26/2024

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