Provider Demographics
NPI:1295262004
Name:BLOMMEL, ERIC JOSEPH (MA, LPC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JOSEPH
Last Name:BLOMMEL
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3674 S NEPAL ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-7433
Mailing Address - Country:US
Mailing Address - Phone:720-675-7235
Mailing Address - Fax:
Practice Address - Street 1:6200 S SYRACUSE WAY STE 260
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4739
Practice Address - Country:US
Practice Address - Phone:720-675-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0104825106H00000X
COLPC.0017452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist