Provider Demographics
NPI:1467167726
Name:BLOMGREN, CANDY JEAN (LPC)
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:JEAN
Last Name:BLOMGREN
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:J
Other - Last Name:GJERSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12627 N SUN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3268
Mailing Address - Country:US
Mailing Address - Phone:480-363-3390
Mailing Address - Fax:
Practice Address - Street 1:12627 N SUN VALLEY DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3268
Practice Address - Country:US
Practice Address - Phone:480-363-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20847101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional