Healthcare Provider Details

I. General information

NPI: 1174217392
Provider Name (Legal Business Name): CHLOE MARIE BLOOM LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHLOE MARIE BLEVINS PCLC

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 8TH ST N STE A
GREAT FALLS MT
59401-1517
US

IV. Provider business mailing address

601 1ST AVE N
GREAT FALLS MT
59401-2510
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-6973
  • Fax: 406-791-9277
Mailing address:
  • Phone: 406-454-6973
  • Fax: 406-791-9277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-88261
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-PCLC-LIC-62428
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: