Frederick M Blum, MFT, PHD.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY23388 Issued in CA

Practice address

16955 Lemon St
Hesperia, CA 92345-5139

Phone

(760) 947-8223

Fax

(760) 947-8225

NPI assigned

Sep 11, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Lodgequest

  • Community/Behavioral Health Agency
  • Hesperia, CA
  • NPI 1659579738
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1053506147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 SANDALWOOD DR",
            "city": "CALIMESA",
            "state": "CA",
            "postal_code": "923201634",
            "telephone_number": "951-533-7467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16955 LEMON ST",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923455139",
            "telephone_number": "760-947-8223",
            "fax_number": "760-947-8225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUM",
        "first_name": "FREDERICK",
        "middle_name": "M",
        "credential": "MFT, PHD.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-11",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC 23846",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY23388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elaine Abante Bersaba Vong, DDS
• Hanser Beunes Soler, MD
• Harbir Bhullar, D.D.S.
• Carli Scott Bisaillon
• Cheryl Mae Bishop
• Johnette Dashay Board, NURSING LICENSE
• Amber Louise Courtney Bobo
• Kimberly Michelle Bracone
• Brad W Hannon Inc
• Elisa Marie Starnes Braggins, LMFT

• Clinical Psychologist in Hesperia, CA
• Providers in Hesperia, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.