Provider Demographics
NPI:1861737983
Name:BLUM, JOANNE C (LMHC, NCC)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:C
Last Name:BLUM
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7112 NE 132ND ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-1618
Mailing Address - Country:US
Mailing Address - Phone:919-306-1856
Mailing Address - Fax:253-322-2226
Practice Address - Street 1:10516 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3714
Practice Address - Country:US
Practice Address - Phone:919-306-1856
Practice Address - Fax:253-322-2226
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60607262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health