Mr William Jesse Black, LICSW, LADC, BCD is a
Counselor - Addiction (substance Use Disorder) based in Barstow, California. Mr William Jesse Black is licensed to practice in Minnesota (license number 300555) and his current practice location is
271 Cypress Drive, Barstow, California. He can be reached at his office (for appointments etc.) via phone at
(507) 732-4136.
NPI number for Mr William Jesse Black is 1972716314 and his current mailing address is 271 Cypress Drive, Barstow, California. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1972716314.
Healthcare Provider's Profile
| Full Name | Mr William Jesse Black |
|---|
| Gender | Male |
|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
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| Location | 271 Cypress Drive, Barstow, California |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1972716314
- Provider Enumeration Date: 05/08/2007
- Last Update Date: 06/21/2021
Medical Identifiers
Medical identifiers for Mr William Jesse Black such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1972716314 | NPI | - | NPPES |
| 1972716314 | Medicaid | MN | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1041C0700X | Social Worker - Clinical | 4476 (Minnesota) | Secondary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 300555 (Minnesota) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr William Jesse Black is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr William Jesse Black, LICSW, LADC, BCD
271 Cypress Drive,
Barstow, CA 92311
Ph: () - | Mr William Jesse Black, LICSW, LADC, BCD
271 Cypress Drive,
Barstow, CA 92311
Ph: (507) 732-4136 |
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