Provider Demographics
NPI:1124022736
Name:BLUM, STEPHEN H (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:H
Last Name:BLUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 SW WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1446
Mailing Address - Country:US
Mailing Address - Phone:785-233-9400
Mailing Address - Fax:785-233-9090
Practice Address - Street 1:835 SW WESTERN AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1446
Practice Address - Country:US
Practice Address - Phone:785-233-9400
Practice Address - Fax:785-233-9090
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP0648103T00000X
MOPYR0251103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100238790AMedicaid
MO15917014OtherMO BCBS NUMBER
KSR30887Medicare UPIN
KS100238790AMedicaid
KS0000007062Medicare ID - Type UnspecifiedMEDICARE NUMBER