Provider Demographics
NPI:1942365184
Name:BLUME, THOMAS W (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:BLUME
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36700 WOODWARD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0926
Mailing Address - Country:US
Mailing Address - Phone:284-760-2317
Mailing Address - Fax:
Practice Address - Street 1:36700 WOODWARD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0926
Practice Address - Country:US
Practice Address - Phone:284-760-2317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003793101YP2500X
MI4101005465106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist