Active NPI
Amanda L Bloom, BS
- Counselor
- Logansport, IN
National Provider Identifier
1013287671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 1807 Smith St
Logansport, IN 46947-1576 - Phone
- (574) 732-1414
- Fax
- (574) 732-0504
- NPI assigned
- Jan 12, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary | ||
| Case Manager/Care Coordinator | 171M00000X |
Addresses
Primary practice location
1807 Smith St
Logansport, IN 46947-1576
Mailing address
1807 Smith St
Logansport, IN 46947-1576
Phone (574) 732-1414
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Four County Comprehensive Mental Health Center, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326326400000",
"number": "1013287671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1807 SMITH ST",
"city": "LOGANSPORT",
"state": "IN",
"postal_code": "469471576",
"telephone_number": "574-732-1414",
"fax_number": "574-732-0504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1807 SMITH ST",
"city": "LOGANSPORT",
"state": "IN",
"postal_code": "469471576",
"telephone_number": "574-732-1414",
"fax_number": "574-732-0504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOOM",
"first_name": "AMANDA",
"middle_name": "L",
"credential": "BS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-12",
"last_updated": "2012-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Logansport, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.