Individual
CHARLES MICHAEL BLOOM, JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QMHP
Contact information
Practice address
1651 CENTENNIAL BLVD, SPRINGFIELD, OR 97477-3363
(541) 726-2467
(541) 684-4156
Mailing address
687 CHESHIRE AVE, EUGENE, OR 97402-5060
(541) 684-4100
(541) 684-4156
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/08/2019
Last updated
01/06/2020
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