Provider Demographics
NPI:1952557670
Name:BLUME, MICHELE LORRAINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LORRAINE
Last Name:BLUME
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18851 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4202
Mailing Address - Country:US
Mailing Address - Phone:714-357-6500
Mailing Address - Fax:
Practice Address - Street 1:2200 PACIFIC COAST HWY STE 215
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2701
Practice Address - Country:US
Practice Address - Phone:714-357-6500
Practice Address - Fax:714-357-6500
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24331103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist