Provider Demographics
NPI:1457774523
Name:BLOOMQUIST, EMILY A (MFT)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:A
Last Name:BLOOMQUIST
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 LANDER ST # 204D
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1552
Mailing Address - Country:US
Mailing Address - Phone:775-686-9294
Mailing Address - Fax:
Practice Address - Street 1:527 LANDER ST # 204D
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1552
Practice Address - Country:US
Practice Address - Phone:775-686-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0467106H00000X
NV01414106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist