Provider Demographics
NPI:1821278078
Name:BLUM, BRENDA L (ACWS)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:BLUM
Suffix:
Gender:F
Credentials:ACWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 S CONYER ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4631
Mailing Address - Country:US
Mailing Address - Phone:559-308-1745
Mailing Address - Fax:
Practice Address - Street 1:320 W OAK AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4929
Practice Address - Country:US
Practice Address - Phone:559-625-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30277101YM0800X
CA280121041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health