Healthcare Provider Details

I. General information

NPI: 1124357306
Provider Name (Legal Business Name): ALEX BLOOM PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8285 SW NIMBUS AVE STE 130
BEAVERTON OR
97008-6428
US

IV. Provider business mailing address

399 E 10TH AVE
EUGENE OR
97401-3380
US

V. Phone/Fax

Practice location:
  • Phone: 503-610-2044
  • Fax: 503-296-2102
Mailing address:
  • Phone: 541-868-2004
  • Fax: 541-868-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2330
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: