Healthcare Provider Details

I. General information

NPI: 1114045465
Provider Name (Legal Business Name): CHAMBERS & BLOHM PSYCHOLOGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N MANDAN ST STE 1
BISMARCK ND
58501-3886
US

IV. Provider business mailing address

309 N MANDAN ST STE 1
BISMARCK ND
58501-3886
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-0924
  • Fax: 701-323-0935
Mailing address:
  • Phone: 701-323-0924
  • Fax: 701-323-0935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHY BLOHM
Title or Position: OWNER
Credential:
Phone: 701-323-0924