MEDICARE: BALANCE AND BLOOM BEHAVIORAL HEALTH 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1861359739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCE AND BLOOM BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	4656 VALENTINA RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-0855
Country	:	US
Telephone Number	:	828-772-0128
Fax Number	:

Provider Business Practice Location Address
First Line	:	4656 VALENTINA RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-0855
Country	:	US
Telephone Number	:	828-772-0128
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL THERAPIST
Name	:	JORDAN B ROSENBLUTH
Credential	:	LCSW
Telephone Number	:	828-772-0128

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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