Healthcare Provider Details

I. General information

NPI: 1245150291
Provider Name (Legal Business Name): DESERT BLOOM MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3926 SANDALWOOD LN
PUEBLO CO
81005-2586
US

IV. Provider business mailing address

3926 SANDALWOOD LN
PUEBLO CO
81005-2586
US

V. Phone/Fax

Practice location:
  • Phone: 719-420-1320
  • Fax: 719-888-1749
Mailing address:
  • Phone: 719-420-1320
  • Fax: 719-888-1749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA FOSTER
Title or Position: OWNER
Credential: APRN
Phone: 719-420-1320