Provider Demographics
NPI:1427570431
Name:BLOOMCAMP, HEATHER (LPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BLOOMCAMP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8629 BLUEJACKET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1700
Mailing Address - Country:US
Mailing Address - Phone:913-677-3553
Mailing Address - Fax:
Practice Address - Street 1:8629 BLUEJACKET ST STE 100
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1700
Practice Address - Country:US
Practice Address - Phone:913-677-3553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100240930AMedicaid