Healthcare Provider Details

I. General information

NPI: 1063609923
Provider Name (Legal Business Name): DINA DURAN BLUME LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11211 KATY FWY
HOUSTON TX
77079-2126
US

IV. Provider business mailing address

13114 BOHEME DR
HOUSTON TX
77079-7206
US

V. Phone/Fax

Practice location:
  • Phone: 713-365-0700
  • Fax:
Mailing address:
  • Phone: 713-467-1947
  • Fax: 713-467-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20262
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: