Healthcare Provider Details

I. General information

NPI: 1861359739
Provider Name (Legal Business Name): BALANCE AND BLOOM BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4656 VALENTINA RD
LAS CRUCES NM
88012-0855
US

IV. Provider business mailing address

4656 VALENTINA RD
LAS CRUCES NM
88012-0855
US

V. Phone/Fax

Practice location:
  • Phone: 828-772-0128
  • Fax:
Mailing address:
  • Phone: 828-772-0128
  • 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: JORDAN B ROSENBLUTH
Title or Position: CLINICAL THERAPIST
Credential: LCSW
Phone: 828-772-0128