Provider Demographics
NPI:1114045465
Name:CHAMBERS & BLOHM PSYCHOLOGICAL
Entity Type:Organization
Organization Name:CHAMBERS & BLOHM PSYCHOLOGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-323-0924
Mailing Address - Street 1:309 N MANDAN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3886
Mailing Address - Country:US
Mailing Address - Phone:701-323-0924
Mailing Address - Fax:701-323-0935
Practice Address - Street 1:309 N MANDAN ST STE 1
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3886
Practice Address - Country:US
Practice Address - Phone:701-323-0924
Practice Address - Fax:701-323-0935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND2045001OtherBCBS OF NORTH DAKOTA
ND12294Medicaid
ND2045001OtherBCBS OF NORTH DAKOTA