Provider Demographics
NPI:1487989893
Name:BLOOMQUIST, DARCY ELAINE (LMSW)
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:ELAINE
Last Name:BLOOMQUIST
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2053 S RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-5235
Mailing Address - Country:US
Mailing Address - Phone:316-371-2965
Mailing Address - Fax:
Practice Address - Street 1:266 N MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-1516
Practice Address - Country:US
Practice Address - Phone:316-305-2964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-03
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7471104100000X
KS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)