Healthcare Provider Details

I. General information

NPI: 1508467333
Provider Name (Legal Business Name): PAULA J. BLOOM MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAULA DULCE BS

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CLUB RD STE NO350
EUGENE OR
97401-2420
US

IV. Provider business mailing address

147 AYERS RD
EUGENE OR
97408-1604
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-1728
  • Fax:
Mailing address:
  • Phone: 408-890-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC7178
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: