Provider Demographics
NPI:1346654373
Name:GOLDSTROM, DONNA BLUBAUGH (LPC , LAC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:BLUBAUGH
Last Name:GOLDSTROM
Suffix:
Gender:F
Credentials:LPC , LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 CHAROLAIS DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1407
Mailing Address - Country:US
Mailing Address - Phone:970-691-2333
Mailing Address - Fax:
Practice Address - Street 1:3320 W EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-9176
Practice Address - Country:US
Practice Address - Phone:970-691-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional