MEDICARE: BLOOM CHILD THERAPISTS 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	:	1497352942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM CHILD THERAPISTS PLLC

Provider Business Mailing Address
First Line	:	19590 E MAINSTREET STE 100-5
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80138-7302
Country	:	US
Telephone Number	:	303-968-1390
Fax Number	:

Provider Business Practice Location Address
First Line	:	19590 E MAINSTREET STE 100-5
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80138-7302
Country	:	US
Telephone Number	:	303-968-1390
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KERI SAWYER
Credential	:	LPC, LCPC
Telephone Number	:	303-968-1390

Provider Enumeration Date	:	10/07/2020
Last Update Date	:	06/12/2023

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