Healthcare Provider Details

I. General information

NPI: 1336655174
Provider Name (Legal Business Name): BLOOM THERAPY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 12/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E HOLLY ST STE 522
BELLINGHAM WA
98225-4728
US

IV. Provider business mailing address

103 E HOLLY ST STE 522
BELLINGHAM WA
98225-4728
US

V. Phone/Fax

Practice location:
  • Phone: 360-988-3432
  • Fax:
Mailing address:
  • Phone: 360-988-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number604156568
License Number StateWA

VIII. Authorized Official

Name: APRIL E. MULLEN
Title or Position: OWNER/OPERATOR
Credential: LMHC
Phone: 360-988-3432