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NPI Code Detail

MEDICARE: LUNA BLOOM PSYCHIATRY LLC

MEDICARE: LUNA BLOOM PSYCHIATRY LLC
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)
2261QM0855XAdolescent and Children Mental Health Clinic/Center
3251S00000XCommunity/Behavioral Health Agency
4261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1578427381
Entity Type Code : Organization
Provider Name (Legal Business Name) : LUNA BLOOM PSYCHIATRY LLC
Provider Business Mailing Address
First Line : 2025 RIVERSIDE DR STE 618
Second Line :
City : COLUMBUS
State : OH
Zip : 43221-4012
Country : US
Telephone Number : 614-324-9099
Fax Number :
Provider Business Practice Location Address
First Line : 2025 RIVERSIDE DR STE 618
Second Line :
City : COLUMBUS
State : OH
Zip : 43221-4012
Country : US
Telephone Number : 614-324-9099
Fax Number :
Authorized Official
Title or Position : CEO
Name : MRS. ASHLEY NERUSU
Credential :
Telephone Number : 614-324-9099
Provider Enumeration Date : 12/15/2025
Last Update Date : 03/05/2026

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Directions to “LUNA BLOOM PSYCHIATRY LLC ” Practice Location

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