Provider Demographics
NPI:1467167726
Name:BLOMGREN, CANDY JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:JEAN
Last Name:BLOMGREN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:J
Other - Last Name:GJERSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3425 W DEER VALLEY RD UNIT 105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2260
Mailing Address - Country:US
Mailing Address - Phone:928-800-4177
Mailing Address - Fax:
Practice Address - Street 1:3425 W DEER VALLEY RD UNIT 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2260
Practice Address - Country:US
Practice Address - Phone:928-800-4177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20847101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional