Provider Demographics
NPI:1386883932
Name:BLACKSHEAR, EARNEST HOWARD-RUDOLPH JR (PHD)
Entity type:Individual
Prefix:DR
First Name:EARNEST
Middle Name:HOWARD-RUDOLPH
Last Name:BLACKSHEAR
Suffix:JR
Gender:M
Credentials:PHD
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Mailing Address - Street 1:5836 BELUGA BAY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6843
Mailing Address - Country:US
Mailing Address - Phone:702-941-0583
Mailing Address - Fax:702-832-1940
Practice Address - Street 1:5836 BELUGA BAY ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6843
Practice Address - Country:US
Practice Address - Phone:702-941-0583
Practice Address - Fax:702-832-1940
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2022-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVPY0864103TC0700X
AL0000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical