Healthcare Provider Details

I. General information

NPI: 1861303653
Provider Name (Legal Business Name): LUNAR BLOOM COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 FAUNCE CORNER RD UNIT 320
DARTMOUTH MA
02747-1276
US

IV. Provider business mailing address

84 FAUNCE CORNER RD UNIT 320
DARTMOUTH MA
02747-1276
US

V. Phone/Fax

Practice location:
  • Phone: 508-709-6133
  • Fax:
Mailing address:
  • Phone: 508-709-6133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. BREANN AHLMAN
Title or Position: OWNER
Credential: LMHC
Phone: 651-269-1156