Healthcare Provider Details

I. General information

NPI: 1629902309
Provider Name (Legal Business Name): BRANCH AND BLOOM COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 ROCK LEDGE CT
MONTGOMERY AL
36117-7682
US

IV. Provider business mailing address

416 ROCK LEDGE CT
MONTGOMERY AL
36117-7682
US

V. Phone/Fax

Practice location:
  • Phone: 334-782-4803
  • Fax:
Mailing address:
  • Phone: 334-782-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: FALLON REYNOLDS
Title or Position: MENTAL HEALTH THERAPIST
Credential: EDS, LPC
Phone: 334-782-4803