Provider Demographics
NPI:1114341104
Name:BLASIUS, BRIDGET M (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:M
Last Name:BLASIUS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3954 YOUNGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-3865
Mailing Address - Country:US
Mailing Address - Phone:303-995-8512
Mailing Address - Fax:
Practice Address - Street 1:3954 YOUNGFIELD ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3865
Practice Address - Country:US
Practice Address - Phone:303-995-8512
Practice Address - Fax:720-328-0769
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0014956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty