MEDICARE: CAITLIN BLOOM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	271404	KY

General Provider Information

NPI Number	:	1356041313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN BLOOM

Provider Business Mailing Address
First Line	:	290 HICKORY HILL DR
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-2856
Country	:	US
Telephone Number	:	423-443-5719
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 HICKORY HILL DR
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-2856
Country	:	US
Telephone Number	:	423-443-5719
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	03/08/2023

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Directions to “ CAITLIN BLOOM ” Practice Location

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