Provider Demographics
NPI:1124847868
Name:BLOOMINGDALE, MARAN CAMPBELL (LCMHC)
Entity type:Individual
Prefix:
First Name:MARAN
Middle Name:CAMPBELL
Last Name:BLOOMINGDALE
Suffix:
Gender:
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 S HIGHLAND DR STE 310
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3760
Mailing Address - Country:US
Mailing Address - Phone:801-996-3413
Mailing Address - Fax:
Practice Address - Street 1:7050 S HIGHLAND DR STE 310
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-3760
Practice Address - Country:US
Practice Address - Phone:801-996-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12149047-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health