Provider Demographics
NPI:1437221710
Name:BLUM, JERILYNN (LCPC)
Entity Type:Individual
Prefix:
First Name:JERILYNN
Middle Name:
Last Name:BLUM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 ROBERT ST
Mailing Address - Street 2:STE 102
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2528
Mailing Address - Country:US
Mailing Address - Phone:208-724-9502
Mailing Address - Fax:208-429-1865
Practice Address - Street 1:1510 ROBERT ST
Practice Address - Street 2:STE 102
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2528
Practice Address - Country:US
Practice Address - Phone:208-429-1865
Practice Address - Fax:208-429-1865
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ7106OtherID BLUE CROSS PROVIDER ID
ID000010028621OtherRBSI PROVIDER ID