Provider Demographics
NPI:1346993904
Name:BLUME, KATHLEEN ELIZABETH (MSW, LCSW, QMAP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:BLUME
Suffix:
Gender:F
Credentials:MSW, LCSW, QMAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 MEADOW VIEW RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9502
Mailing Address - Country:US
Mailing Address - Phone:720-593-8817
Mailing Address - Fax:
Practice Address - Street 1:6655 W JEWELL AVE STE 113
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-7148
Practice Address - Country:US
Practice Address - Phone:720-593-8817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002086101YA0400X
CO1028376K00000X
COCSW.099280001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No376K00000XNursing Service Related ProvidersNurse's Aide