MEDICARE: NEURO BLOOM COUNSELING AND NEUROFEEDBACK, PLLC

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

General Provider Information

NPI Number	:	1457179913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO BLOOM COUNSELING AND NEUROFEEDBACK, PLLC

Provider Business Mailing Address
First Line	:	13654 XAVIER LN STE 201
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80023-3608
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 W 120TH AVE STE 218
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80234-2710
Country	:	US
Telephone Number	:	720-523-1067
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TANJA GORENC
Credential	:	MA, LMFT, BCN
Telephone Number	:	720-490-9939

Provider Enumeration Date	:	10/02/2024
Last Update Date	:	10/02/2024

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