Healthcare Provider Details

I. General information

NPI: 1467374793
Provider Name (Legal Business Name): INNERBLOOM PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 BRODIE LN STE 205
AUSTIN TX
78748-6284
US

IV. Provider business mailing address

9701 BRODIE LN STE 205
AUSTIN TX
78748-6284
US

V. Phone/Fax

Practice location:
  • Phone: 956-225-3768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JONATHAN J CABALLERO
Title or Position: OWNER
Credential:
Phone: 956-225-3768