Active NPI
Larry Jay Bloom, PH.D.
- Health Service Psychologist
- Fort Collins, CO
National Provider Identifier
1407878051
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Service Psychologist
- License
- 500
- Practice address
- Of Psychology Colorado State University
Ft Collins, CO 80523-0001 - Phone
- (970) 491-5214
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Psychologist | 103TH0100X | 500 | CO | Primary |
Addresses
Primary practice location
Of Psychology Colorado State University
Ft Collins, CO 80523-0001
Mailing address
1000 Southpark Drive
Littleton, CO 80120-5654
Phone (303) 715-2264
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2025 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 500 | CO | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280275200000",
"number": "1407878051",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 SOUTHPARK DRIVE",
"city": "LITTLETON",
"state": "CO",
"postal_code": "801205654",
"telephone_number": "303-715-2264",
"fax_number": "303-703-2118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "OF PSYCHOLOGY COLORADO STATE UNIVERSITY",
"city": "FT COLLINS",
"state": "CO",
"postal_code": "805230001",
"telephone_number": "970-491-5214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOOM",
"first_name": "LARRY",
"middle_name": "JAY",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2010-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "CO",
"license": "500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
- Frederick M. Blesch, D.C.
- Lindsay A Bliss Raab, LCSW
- Alexander Blitch, MD
- Douglas Watson Blocksma, MA, LPC
- Bloom Limited (Bloom)
- Blooming Lotus Counseling LLC
- Ivan D Blount, MS
- Blue Iris Healing & Counseling, PLLC
- Blue Sky Psychological Services
- Blue Spruce Associates, Inc. (Centennial Center for Human Services)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.