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NPI Code Detail

MEDICARE: JUDITH MANHEIM BLUM MFT

MEDICARE: JUDITH MANHEIM BLUM MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFT33487CA

General Provider Information

NPI Number : 1306849930
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH MANHEIM BLUM MFT
Provider Business Mailing Address
First Line : 1627 OAK AVE
Second Line : STE A
City : DAVIS
State : CA
Zip : 95616-1072
Country : US
Telephone Number : 530-756-0555
Fax Number : 530-756-1368
Provider Business Practice Location Address
First Line : 1627 OAK AVE
Second Line : STE A
City : DAVIS
State : CA
Zip : 95616-1072
Country : US
Telephone Number : 530-756-0555
Fax Number : 530-756-1368
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 07/09/2007

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Directions to “ JUDITH MANHEIM BLUM MFT” Practice Location

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