Provider Demographics
NPI:1962497750
Name:BLOOM, JUDI E (LPC)
Entity Type:Individual
Prefix:MS
First Name:JUDI
Middle Name:E
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 NORTHWEST FWY
Mailing Address - Street 2:STE 235
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-6530
Mailing Address - Country:US
Mailing Address - Phone:713-956-8194
Mailing Address - Fax:713-683-1684
Practice Address - Street 1:11500 NORTHWEST FWY
Practice Address - Street 2:STE 235
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-6530
Practice Address - Country:US
Practice Address - Phone:713-956-8194
Practice Address - Fax:713-683-1684
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14561101YM0800X
TX14531106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist