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NPI Code Detail

MEDICARE: BLOOM COUNSELING AND ASSOCIATES

MEDICARE: BLOOM COUNSELING AND ASSOCIATES
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11578876176OTHERILNPI

General Provider Information

NPI Number : 1891637898
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLOOM COUNSELING AND ASSOCIATES
Provider Business Mailing Address
First Line : 2609 MONTEGA DR STE B
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62704-7011
Country : US
Telephone Number : 217-971-3182
Fax Number :
Provider Business Practice Location Address
First Line : 2609 MONTEGA DR STE B
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62704-7011
Country : US
Telephone Number : 217-971-3182
Fax Number :
Authorized Official
Title or Position : PARNTER
Name : MRS. JILL TALAVERA
Credential : LCPC, CADC, PCGC
Telephone Number : 217-971-3182
Provider Enumeration Date : 04/08/2026
Last Update Date : 04/08/2026

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