Healthcare Provider Details

I. General information

NPI: 1437382710
Provider Name (Legal Business Name): DIANNA L BLOM LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ENCINO PL NE STE E1
ALBUQUERQUE NM
87102-2645
US

IV. Provider business mailing address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

V. Phone/Fax

Practice location:
  • Phone: 505-715-8525
  • Fax: 505-272-7751
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2024-9543
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: