Individual
LARRY JAY BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
OF PSYCHOLOGY COLORADO STATE UNIVERSITY, FT COLLINS, CO 80523-0001
(970) 491-5214
Mailing address
1000 SOUTHPARK DRIVE, LITTLETON, CO 80120-5654
(303) 715-2264
(303) 703-2118
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
500
CO
Other
Enumeration date
07/24/2006
Last updated
07/28/2010
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