Provider Demographics
NPI:1316377781
Name:BARBARA A. BLOM LLC
Entity Type:Organization
Organization Name:BARBARA A. BLOM LLC
Other - Org Name:BARBARA BLOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLOM
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-646-6031
Mailing Address - Street 1:413 COURTLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1829
Mailing Address - Country:US
Mailing Address - Phone:734-646-6031
Mailing Address - Fax:734-975-2909
Practice Address - Street 1:477 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1708
Practice Address - Country:US
Practice Address - Phone:734-646-6031
Practice Address - Fax:734-975-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010583021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty