Healthcare Provider Details

I. General information

NPI: 1346144896
Provider Name (Legal Business Name): LIELA BLOOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 N MOUNT JULIET RD
MOUNT JULIET TN
37122-3007
US

IV. Provider business mailing address

30104 BARTONS RUN TRCE
LEBANON TN
37090-2583
US

V. Phone/Fax

Practice location:
  • Phone: 615-438-3615
  • Fax:
Mailing address:
  • Phone: 256-425-2817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: