Healthcare Provider Details

I. General information

NPI: 1083556369
Provider Name (Legal Business Name): BLOOM WITHIN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 MIDLAND DR
SAINT LOUIS MO
63130-1824
US

IV. Provider business mailing address

1311 MIDLAND DR
SAINT LOUIS MO
63130-1824
US

V. Phone/Fax

Practice location:
  • Phone: 314-643-8159
  • Fax:
Mailing address:
  • Phone: 314-643-8159
  • 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: KEATON ELAINE COLEMAN
Title or Position: MENTAL HEALTH COUNSELOR/CEO
Credential: LCSW
Phone: 314-643-8159