Bryan Allen Bloemendaal, MS, LAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1797 Issued in ND

Practice address

4215 9TH Ave S
Fargo, ND 58103-2018

Phone

(701) 373-8667

NPI assigned

Aug 9, 2016

Last updated

Aug 29, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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)

Not enrolled

Credentials

Master of Science

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sharehouse, Inc

  • Substance Abuse Rehabilitation Facility
  • Fargo, ND
  • NPI 1437537602
  NPD (past)

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

{
    "created_epoch": "1470700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472428800000",
    "number": "1245784156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 40TH AVE S",
            "address_2": "APT 203",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048906",
            "telephone_number": "507-215-2096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4215 9TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032018",
            "telephone_number": "701-373-8667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOEMENDAAL",
        "first_name": "BRYAN",
        "middle_name": "ALLEN",
        "credential": "MS, LAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-09",
        "last_updated": "2016-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "304586",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ND",
            "license": "1797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jan M Blixt, LSW
• Shari Blixt, RN, CDCES
• Tina Bloch
• Andrea Dee Block, LPCC
• Rachel Elizabeth Block, RN
• Lori K Blomquist, LAPC
• Morgan Mae Blood
• Bloom & Belong LLC
• Caitlin Bloom
• Kristin Bloom

• Addiction (Substance Use Disorder) Counselor in Fargo, ND
• Providers in Fargo, ND by specialty
• Addiction (Substance Use Disorder) Counselor in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2016; 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.