Provider Demographics
NPI:1992716955
Name:BLUM, LOIS ROBERTA (LPC, LMFT)
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:ROBERTA
Last Name:BLUM
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 CAPE COD DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-2622
Mailing Address - Country:US
Mailing Address - Phone:361-857-0655
Mailing Address - Fax:361-853-0074
Practice Address - Street 1:4646 CORONA DR
Practice Address - Street 2:SUITE 256
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4320
Practice Address - Country:US
Practice Address - Phone:361-857-0655
Practice Address - Fax:361-853-0074
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9180101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3035LCOtherBLUE CROSS/BLUE SHIELD