Individual
MR. LARRY E. BLOSSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
611 S UNION AVE APT A, PUEBLO, CO 81004-2250
(719) 696-4252
Mailing address
3225 INDEPENDENCE RD, CANON CITY, CO 81212-9380
(719) 275-2351
(719) 269-9386
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701002333
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5409152
—
VA
05
—
5409179
—
VA
Enumeration date
12/13/2006
Last updated
04/19/2022
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