Healthcare Provider Details

I. General information

NPI: 1386313609
Provider Name (Legal Business Name): BLOOM COUNSELING & CO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6645 VINELAND RD STE 270
ORLANDO FL
32819-7840
US

IV. Provider business mailing address

PO BOX 770412
WINTER GARDEN FL
34777-0412
US

V. Phone/Fax

Practice location:
  • Phone: 407-961-9932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JILLIAN SINNAMON
Title or Position: OWNER
Credential: RMHCI
Phone: 407-961-9932