Provider Demographics
NPI:1639320625
Name:BLOOMENSTIEL, LESTER ISAAC (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:LESTER
Middle Name:ISAAC
Last Name:BLOOMENSTIEL
Suffix:
Gender:M
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:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-0776
Mailing Address - Country:US
Mailing Address - Phone:903-482-5128
Mailing Address - Fax:903-482-5128
Practice Address - Street 1:7454 FM 121
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-0776
Practice Address - Country:US
Practice Address - Phone:903-482-5128
Practice Address - Fax:903-482-5128
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional