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NPI Code Detail

MEDICARE: IBLOOM WELLNESS CLINIC PLLC

MEDICARE: IBLOOM WELLNESS CLINIC 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1538968607
Entity Type Code : Organization
Provider Name (Legal Business Name) : IBLOOM WELLNESS CLINIC PLLC
Provider Business Mailing Address
First Line : 5900 BALCONES DR STE 100
Second Line :
City : AUSTIN
State : TX
Zip : 78731-4298
Country : US
Telephone Number : 682-553-7827
Fax Number :
Provider Business Practice Location Address
First Line : 3838 OAK LAWN AVE STE 1000
Second Line :
City : DALLAS
State : TX
Zip : 75219-4511
Country : US
Telephone Number : 682-553-7827
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : CHRISTOLOGUS OBI
Credential :
Telephone Number : 972-375-1634
Provider Enumeration Date : 03/11/2025
Last Update Date : 03/11/2025

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Directions to “IBLOOM WELLNESS CLINIC PLLC ” Practice Location

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