Healthcare Provider Details

I. General information

NPI: 1467242800
Provider Name (Legal Business Name): BLOOM THERAPY TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5293 BENTGRASS DR
STAGECOACH NV
89429-8481
US

IV. Provider business mailing address

62 S MADDUX DR
RENO NV
89512-1831
US

V. Phone/Fax

Practice location:
  • Phone: 775-223-1009
  • Fax:
Mailing address:
  • Phone: 775-223-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALEXA K WALDMANN
Title or Position: OWNER
Credential: LCSW
Phone: 775-223-1009