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General NPI Number Information
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NPI Number | 1184614406
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Entity Type | Individual
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Provider Name | HAROLD RAYMOND BLOSS ED.D.
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11 THE PINES CT SUITE E
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6197
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Country | US
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Telephone | 636-230-4756
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Fax | 636-227-2557
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Provider Business Mailing Address
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Address Line | 2368 FAIRWOOD FOREST CT
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City | CHESTERFIELD
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State | MO
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Zip | 63017-7366
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Country | US
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Telephone | 636-230-4756
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Fax | 636-227-2557
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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 | 00484
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License Number State | MO
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