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General NPI Number Information
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NPI Number | 1023844859
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Entity Type | Individual
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Provider Name | MIRIAM BLUM PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 3225 INTERNATIONAL CIR STE 102
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3161
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Country | US
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Telephone | 719-471-1466
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 62595
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City | COLORADO SPRINGS
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State | CO
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Zip | 80962-2595
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Country | US
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Telephone | 719-531-6078
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Fax | 719-531-5767
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1167
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License Number State | CO
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