Provider Demographics
NPI:1114435526
Name:BLUM, ALLISON RAHCEL (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:RAHCEL
Last Name:BLUM
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:MRS
Other - First Name:ALLISON
Other - Middle Name:RACHEL
Other - Last Name:ROSENBLOOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3155 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6917
Mailing Address - Country:US
Mailing Address - Phone:847-858-2024
Mailing Address - Fax:
Practice Address - Street 1:3155 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-6917
Practice Address - Country:US
Practice Address - Phone:847-858-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076871500Medicaid