Provider Demographics
NPI:1992474225
Name:BLUMEN, ALEXANDRA BELLE
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:BELLE
Last Name:BLUMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 WALNUT DR STE B
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-8939
Mailing Address - Country:US
Mailing Address - Phone:707-268-8722
Mailing Address - Fax:
Practice Address - Street 1:3960 WALNUT DR STE B
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-8939
Practice Address - Country:US
Practice Address - Phone:707-268-8722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator