Healthcare Provider Details

I. General information

NPI: 1881268654
Provider Name (Legal Business Name): BLOOM WOMEN'S COUNSELING, CONSULTING, AND WELLNESS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E DUDLEY ST
MAUMEE OH
43537-3366
US

IV. Provider business mailing address

112 E DUDLEY ST
MAUMEE OH
43537-3366
US

V. Phone/Fax

Practice location:
  • Phone: 419-326-5732
  • Fax: 419-715-0776
Mailing address:
  • Phone: 419-326-5732
  • Fax: 419-715-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY BUSH
Title or Position: OWNER/THERAPIST
Credential: MSW, LISW-S, PMH-C
Phone: 419-326-5732