Provider Demographics
NPI:1184391708
Name:BLOOMFIELD, MARIA N (LMHC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:N
Last Name:BLOOMFIELD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3242 NE 3RD AVE # 391
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2408
Mailing Address - Country:US
Mailing Address - Phone:360-797-5512
Mailing Address - Fax:
Practice Address - Street 1:3717 NE LAUREL ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-6914
Practice Address - Country:US
Practice Address - Phone:360-797-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61075192101YM0800X
WALH61237218101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health