Healthcare Provider Details

I. General information

NPI: 1780500645
Provider Name (Legal Business Name): BLOOM BILLING & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8209 MANOR DR # 119
FORT WAYNE IN
46825-2815
US

IV. Provider business mailing address

8209 MANOR DR
FORT WAYNE IN
46825-2815
US

V. Phone/Fax

Practice location:
  • Phone: 512-648-9943
  • Fax:
Mailing address:
  • Phone: 512-648-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MAKALAH KRICK
Title or Position: OWNER
Credential: LCSW
Phone: 512-648-9943