Blossom, Larry E.
Blossom, Larry E. is an sole proprietor health care provider with primary practice located at 611 S Union Ave Apt A , Pueblo CO 81004-2250. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Blossom, Larry E. can be contacted via phone (719) 696-4252.Contact Information
Primary practice address
611 S Union Ave Apt A
Pueblo CO 81004-2250
Phone: (719) 696-4252
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 0701002333 | Virginia |
Profile Details
| NPI number | 1366503138 |
|---|---|
| LBN Legal business name | Blossom, Larry E. |
| Credentials | Master of Arts (MA) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 13th, 2006 |
| Last updated | Apr 19th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366503138 | NPPES |
| Virginia | MEDICAID | 5409152 | |
| Virginia | MEDICAID | 5409179 |
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