Provider Demographics
NPI:1548958580
Name:BLUM INTEGRATIVE PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:BLUM INTEGRATIVE PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER/RCM
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-231-5472
Mailing Address - Street 1:90 ORCUTT DR
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941-5308
Mailing Address - Country:US
Mailing Address - Phone:307-360-6236
Mailing Address - Fax:
Practice Address - Street 1:90 ORCUTT DR
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941-5308
Practice Address - Country:US
Practice Address - Phone:307-360-6236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)