Provider Demographics
NPI:1508940347
Name:BLOOM, AMY LYNN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N EDISON ST STE 233
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1983
Mailing Address - Country:US
Mailing Address - Phone:509-987-1712
Mailing Address - Fax:509-987-1715
Practice Address - Street 1:201 N EDISON ST STE 233
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1983
Practice Address - Country:US
Practice Address - Phone:509-987-1712
Practice Address - Fax:509-987-1715
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WARC00054749171M00000X
WALH60145862101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator