MEDICARE: BLOOM IN GRACE COUNSELING, 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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1811839723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM IN GRACE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	5510 LINCOLN AVE UNIT 405
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5510 LINCOLN AVE UNIT 405
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3442
Country	:	US
Telephone Number	:	219-577-5124
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	PAIGE LAUERMAN
Credential	:	LCSW
Telephone Number	:	219-577-5124

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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