Provider Demographics
NPI:1497016380
Name:GILBO, BLOSSOM (MS, LPC)
Entity Type:Individual
Prefix:
First Name:BLOSSOM
Middle Name:
Last Name:GILBO
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W MARVIN AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-1648
Mailing Address - Country:US
Mailing Address - Phone:573-783-9248
Mailing Address - Fax:
Practice Address - Street 1:473 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-4369
Practice Address - Country:US
Practice Address - Phone:314-604-9964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health