Individual ProviderColter BloxomCounselorBehavioral Health & Social Service ProvidersPractice Address3420 E Shea Blvd Ste 188, Phoenix, AZ 85028-3354(602) 529-6557PECOS EnrollmentBased on the most recent information from CMS, provider Colter Bloxom does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1336780329Provider TypeIndividualFull NameBloxom, ColterTitleMr.CredentialLPCGenderMaleSole ProprietorYesEnumeration Date10/1/2019Last Updated10/1/2019Contact InformationPractice LocationPractice Address3420 E Shea Blvd Ste 188, Phoenix, AZ 85028-3354Phone(602) 529-6557Fax(480) 485-7938Mailing LocationMailing Address3420 E Shea Blvd Ste 188, Phoenix, AZ 85028-3354Phone(602) 529-6557Fax(480) 485-7938Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense18381Arizona