CARROLL D. BLACKLEDGE MA, P-LPC
NPI 1295292274
Counselor - Professional in Jackson, MS
About Carroll D. Blackledge Ma, P-lpc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CARROLL D. BLACKLEDGE MA, P-LPC (NPI 1295292274) is an individual professional provider in Jackson, Mississippi, licensed in Mississippi (P-0512) and active in the NPI registry since February 2019. He has opted out of Medicare through July 8, 2028.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Opted out of Medicare
Carroll D. Blackledge Ma, P-lpc has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 8, 2024 through July 8, 2028.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Carroll Blackledge's NPI number?
The NPI number for Carroll Blackledge is 1295292274. It was assigned to this individual provider in the NPPES registry on February 26, 2019.
Where is Carroll Blackledge located?
Carroll Blackledge practices at 4500 I 55 N Ste 208, Jackson, MS 39211. The listed phone number is (601) 405-7440.
What is Carroll Blackledge's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Carroll Blackledge enrolled in Medicare?
No. Carroll Blackledge has opted out of Medicare through July 8, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.
When was this NPI record last updated?
The NPPES record for Carroll Blackledge was last updated on February 26, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Carroll D. Blackledge, MA, P-LPC · NPI 1295292274
Professional provider in Jackson, Mississippi. Individual provider, active in the CMS NPPES registry since February 26, 2019.
## Identity
- **NPI:** 1295292274 (Entity type: Individual)
- **Enumerated:** February 26, 2019
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** P-0512 (Mississippi)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 4500 I 55 N STE 208, Jackson, MS 39211-5931
- **Phone:** (601) 405-7440
## Medicare
- **Medicare:** Opted out of Medicare (opt-out affidavit on file, in effect through July 8, 2028); services are provided under private contract
## Record status
- **NPPES last updated:** February 26, 2019
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Source: [NPI Profile](https://npiprofile.com/npi/1295292274) · Data from the CMS NPPES public registry.