Healthcare Provider Details

I. General information

NPI: 1376175521
Provider Name (Legal Business Name): JAMES EDWIN BLACKMON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S SPRING ST
TUPELO MS
38804-4822
US

IV. Provider business mailing address

306 TIMBER CV
OXFORD MS
38655-5871
US

V. Phone/Fax

Practice location:
  • Phone: 662-205-0098
  • Fax: 662-495-4079
Mailing address:
  • Phone: 662-801-0271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0177
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: