Healthcare Provider Details

I. General information

NPI: 1255995577
Provider Name (Legal Business Name): JESSICA L BLOOME MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9955 OSUNA RD NE
ALBUQUERQUE NM
87111-2255
US

IV. Provider business mailing address

9955 OSUNA RD NE
ALBUQUERQUE NM
87111-2255
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-2437
  • Fax:
Mailing address:
  • Phone: 505-585-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2023-0337
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: