Healthcare Provider Details

I. General information

NPI: 1518294032
Provider Name (Legal Business Name): JACQUELINE BLUEM PHD, LMHC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 VETERANS WAY
ORLANDO FL
32827-7401
US

IV. Provider business mailing address

13800 VETERANS WAY
ORLANDO FL
32827-7401
US

V. Phone/Fax

Practice location:
  • Phone: 651-356-2938
  • Fax:
Mailing address:
  • Phone: 651-356-2938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number302710
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2810
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22660
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number012189
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: